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Alcohol Use in Older Women
Abstract & Commentary
This article originally appeared in the January 29, 2011 issue of Internal Medicine Alert.
By Mary Elina Ferris, MD
Dr. Ferris is Clinical Associate Professor, University of Southern California.
Dr. Ferris reports no financial relationship to this field of study. Editor Stephen A. Brunton, MD, Adjunct Clinical Professor, University of North Carolina, Chapel Hill, is a consultant for Amylin, Novo Nordisk, Shionogi Pharma, Takeda, and Teva; he serves on the speaker's bureau for Boehringer Ingelheim, Novo Nordisk, and Teva. Peer reviewer Gerald Roberts, MD, Assistant Clinical Professor of Medicine, Albert Einstein College of Medicine, New York, NY, reports no financial relationships to this field of study.
Synopsis: Although most older women have stable patterns of alcohol use over time, they still need to be periodically questioned about alcohol use since some will increase their intake substantially after age 50 and may develop new risks for alcohol-related problems.
Source: Bobo JK, et al. Alcohol use trajectories in two cohorts of U.S. women aged 50 to 65 at baseline. J Am Geriatr Soc 2010;58:2375-2380.
To investigate the natural history of alcohol intake in women after age 50, two randomly sampled, nationally representative large cohorts of older women initially between the ages of 50 and 65 were followed with biannual questionnaires for concurrent 8-10 year periods. The alcohol use questions covered the preceding 3 months and collected data on days of use and daily amount. These data were used to create group-based models of four drinking trajectories: infrequent or non-drinkers (62% of the largest cohort of 3233 women), increasing drinkers (5%), consistent drinkers (26%), and decreasing drinkers (7%). The percentages from the second cohort of 1017 women were very similar.
The majority of older women studied maintained a stable drinking pattern as they aged: consistent, infrequent, or non-drinkers were 87.7% of the largest cohort and 82.6% of the other cohort. Within the consistent drinkers, there was a trend over time to slightly decrease the amount of drinks per day, from 1.78 to 1.59 drinks in the first group and from 1.62 to 0.99 drinks per day in the second group.
The surprising finding was that 4.9% of the larger cohort and 8.8% of the smaller cohort reported notable increases in the number of drinks per day over the 8-10 years of the study.
This report demonstrates that the vast majority of older women have stable alcohol intake as they age, and may even decrease their intake with time. A similar study of women enrolled at ages 45-64 also found that 81% of baseline drinkers and 88% of non-drinkers reported no change in drinking status over 6 years of follow-up.1
The American Geriatrics Society actually has posted clinical guidelines for low-risk alcohol use in older adults on their web site, and recommends no more than 7 drinks/week with a maximum of 2 drinks on any one occasion. However, these amounts have been questioned since safety may be specific to what medications or chronic diseases are present, and there is scant research support for older adults having different guidelines from younger ages if health status is equivalent.2
The group that merits our attention is the small number who actually may increase their alcohol intake over time and put themselves at risk for alcohol-related complications. The authors promise to publish subsequent reports of which risk factors were associated with increasing and decreasing alcohol use to help us target these groups in the future.