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Am Fam Physician. 2007;76(6):868-871

Background: Older age is associated with increased sensitivity to alcohol. Because of this, some nations (e.g., the United States) have lower recommendations for safe alcohol limits in persons 65 years or older. Others (e.g., the United Kingdom) recommend the same limits for older and younger persons. Moderate drinking is associated with lower mortality than either abstinence or heavy drinking in younger persons. This study examined the relationship between alcohol consumption and cognitive and physical functioning, as well as mortality, in older persons in the United States and the United Kingdom. The authors focused on differences between those with a daily intake of greater than zero to one drink and those with a daily intake of greater than one to two drinks.

Methods: The study used data from the U.S. Health and Retirement Study (HRS) and the English Longitudinal Study of Aging (ELSA). Measures of alcohol consumption based on questions related to frequency and quantity of alcohol use were extracted from the data. Outcome measures were activities of daily living (ADLs), instrumental activities of daily living (IADLs), cognitive function, and mortality.

Results: A pooled analysis using data from HRS and ELSA included 5,759 men and 7,574 women; a longitudinal analysis using HRS data included 2,338 men and 3,698 women; and a longitudinal analysis using ELSA data included 1,152 men and 1,471 women. Over a four-year period, there were no statistically significant differences in any outcome measures related to a rise in drinking level from the reference category (greater than zero to one drink) to moderate drinking (greater than one to two drinks). For those drinking more than one to two drinks per day, the odds ratios (ORs) in the pooled analysis were 0.96 for reported difficulty with ADLs, 0.75 for reported difficulty with IADLs, and 0.82 for poor cognitive function. In the longitudinal HRS analysis, in which mortality and functioning outcomes were combined, ORs were 0.93 for ADL problems or mortality, 1.06 for IADL problems or mortality, and 1.00 for poor cognitive function and mortality. In the longitudinal ELSA data, ORs were 0.94 for ADL problems, 0.72 for IADL problems, and 0.93 for poor cognitive function. Nondrinkers had significantly higher relative risks of negative outcomes than the moderate drinkers in all measures except cognitive function. Various sensitivity analyses did not change any of these findings.

Conclusions: There did not appear to be any statistically significant health or mortality risk increase in older persons consuming greater than one to two drinks of alcohol per day. The benefits of moderate alcohol consumption on disability and mortality probably occur through cardiovascular risk reduction. Although these findings should not lead to recommendations of increased alcohol intake, they do suggest that guidelines for older adults need not be overly restrictive relative to recommendations for younger adults.

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Copyright © 2007 by the American Academy of Family Physicians.

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