Alcohol use of older adults: drinking alcohol for medicinal purposes

SIR—Of Finnish adults aged 65–84 years, 54% of females and 77% of males had consumed alcohol in the preceding year in 2007 [1–3]. Older adults are sensitive to the effects of alcohol as a consequence of the physiological changes associated with ageing, a high prevalence of diseases and the concomitant use of multiple drugs. Older adults also experience higher blood alcohol concentrations for a given amount of alcohol than younger adults due to changes in body mass [4]. Research on older people's use of alcohol has focused mainly on problem-drinking and consequent health problems [5, 6]. However, there is also public awareness about the possible health promoting effects of moderate alcohol consumption demonstrated in epidemiological studies [7–13]. Alcohol has been used throughout history for medicinal purposes; since antiquity, wine has been believed to stimulate appetite and digestion [14]. Very few studies are available on how older people perceive the health effects of alcohol, and how they use alcohol for medicinal purposes [15]. The aim of this study was to investigate the medicinal use of alcohol by individuals aged 65 years and older. We investigated (i) the prevalence of alcohol consumption as self-medication, (ii) associated factors and (iii) the reasons for which alcohol is used to self-medicate. In May 2007, a postal questionnaire was sent to computer-generated random sample of 2,100 older persons (≥65 years) from the Espoo Population Register, and re-sent after 3 months to non-respondents. Espoo is a city with 240,000 inhabitants (10% >64 years olds). The number of the potential respondents was 1973 when those in permanent institutional care (n = 92), deceased (n = 16), with native language other than Finnish/Swedish (n = 31) or with unknown address (n = 14) were excluded. Altogether 1,395 individuals returned the questionnaire (response rate 71.6%). The local ethics committee approved the study protocol. A structured questionnaire was piloted prior to the postal survey on 17 elderly individuals to ensure that the questions were easy to understand. The question items concerning demographics and health-related variables were retrieved from our previous epidemiological studies [16–18]. The questionnaire consisted of demographic and health-related variables. In addition, respondents were asked to list any medical diagnoses received from their doctors. Some categorisations were made for health-related factors and current use of medications. Charlson comorbidity index was constructed from medical diagnoses. It is a weighted index taking into account the number and severity of comorbid conditions [19]. To analyse the number of regularly prescribed drugs, participants were inquired to list their prescribed drugs. Alcohol consumption was charted with several questions developed from the clinical guidelines for alcohol use in older adults [20] and the AUDIT (alcohol use disorders identification test) [21]. Quantity and frequency were ascertained by asking: ‘How often do you have a drink containing alcohol, including beer, cider, wine, or liquor; spirits?’, and ‘On a typical day when you drink, how many drinks do you have?’ (1 drink = can or bottle (330 ml) of beer, 12 cl of wine, 4 cl of liquor; spirits (one shot-glass), or 8 cl of sherry or madeira or aperitif. Alcohol-related problems were inquired: (i) ‘Have you forgotten to take your medication when you have used alcohol (never/sometimes/often)?’; (ii) ‘Has any of your relatives or friends been concerned about your drinking or suggested that you should cut down your drinking (never/yes, but not during the last year/yes, during the last year)?’ and (iii) ‘Have you been concerned about your own drinking (yes/no)?’. Alcohol consumption for medicinal purposes was determined by the question ‘Do you use alcohol for medicinal purposes (yes/no), if so, for what conditions?’ Thus, the question regarding the purposes of medicinal use of alcohol was open-ended. Respondents could give more than one condition. From the open-ended responses, we constructed eight most common conditions for consuming alcohol for medicinal purposes. Data were presented with statistical variables including frequencies and percentages. The Chi-square test was used to compare categorical variables and the Mann–Whitney test to compare continuous, non-normally distributed variables. Logistic regression analysis was used to determine whether diagnoses or medical problems were independently associated with alcohol use for medicinal purposes. Confidence intervals were calculated as described [22]. Of the total sample (n = 1,395), 241 persons (17.3%) responded that they used alcohol as a medicine (Table 1). The medicinal consumption of alcohol was more common in the oldest age group. Both genders used this self-medication equally. Marital status did not differ between those who used alcohol as a medicine and those who did not. High income was associated with a lower frequency of using alcohol for medicinal purposes. Sociodemographic and health-related factors and use of alcohol as a medicine aDifferences between the groups were tested with Chi-square test or Fisher exact test. bDifferences between the groups were tested with Mann–Whitney U test. Sociodemographic and health-related factors and use of alcohol as a medicine aDifferences between the groups were tested with Chi-square test or Fisher exact test. bDifferences between the groups were tested with Mann–Whitney U test. The frequency of alcohol consumption was higher among those using alcohol for medicinal purposes than among others. However, the typical amount of alcohol consumed did not differ between the groups. Those using alcohol for medicinal purposes had more often forgotten to take their daily medications than those not using alcohol as a medicine. In addition, their relatives or friends had more often been concerned about their drinking during the last year than those not using alcohol as a medicine (Table 1). Those considering themselves unhealthy or very unhealthy used alcohol more often for medicinal purposes than those considering themselves healthy or very healthy. Those who used alcohol for medicinal purposes had a higher Charlson comorbidity index and higher mean number of regularly used drugs (Table 1). Using alcohol for medicinal purposes was associated with prior myocardial infarction, asthma, rheumatoid arthritis/osteoarthritis, dementia and depression. Those using alcohol to self-medicate had fallen during the last 6 months or suffered from a fracture in adulthood more often than the others (Table 2). However, in logistic regression analysis adjusted for age and income, only depression remained statistically significantly associated with using alcohol for medicinal purposes (OR: 1.6 (95% CI: 1.1–2.4)). Respondents' use of alcohol as self-medication and their reported diagnoses and medical problems Respondents' use of alcohol as self-medication and their reported diagnoses and medical problems The most common conditions for which participants responded using alcohol as a medicine were cardiovascular diseases (34.4%), sleep disturbances (22.1%), common cold (19.9%) and indigestion (14.0%). It was also used for relaxation (6.8%), stimulation (6.3%), pain (3.2%) and general prevention of illnesses (3.6%). Other reasons (8.6%) included doctor's prescription, vertigo, faintness, hangover and red wine for anaemia. Of the total sample, 17.3% responded that they used alcohol for medicinal purposes. The medicinal consumption of alcohol was more common in the oldest age group and in persons with chronic conditions. Those using alcohol for medicinal purposes consumed it more frequently than others. The most commonly mentioned conditions for which alcohol was used were cardiovascular diseases, sleep disturbances, common cold and indigestion. Strength of this study is the large, representative sample of the home-dwelling elderly including very old age groups. A high response rate (71.6%) supports the validity of study. Our study also has some limitations. It relies on self-reporting of alcohol consumption and diagnoses. Self-reported alcohol consumption is likely to be underestimated to some extent in drinking surveys [23]. Diagnoses were also assessed through self-report, which assume that individuals are aware of them. The cross-sectional nature of this study limits our ability to fully explore the associations identified. The most commonly mentioned medical conditions for which alcohol was used were strikingly similar to a previous study [15] in which the material was also collected in Finland. To our knowledge, this is the only previous study reporting medicinal alcohol use at the community level in older adults. In Aira's study [15] alcohol was used for cardiovascular diseases (38%), sleep disturbances (26%), mental problems (23%) and common cold (10%). Our respondents did not mention mental conditions as a reason to use alcohol even though diagnosis of depression was associated with using alcohol for medicinal purposes. Previous studies have revealed that alcohol may be used to relieve depression and anxiety [23–27]. However, those mentioning alcohol as a relaxant (6.8%) or stimulant (6.3%) may include individuals using alcohol for mental problems. The use of alcohol to treat a common cold (19.9%) or indigestion (14.0%) was more common in our population. Some (3.6%) of our respondents mentioned using alcohol to prevent illnesses. Some studies have investigated the use of alcohol to treat pain in the general population [28] which was rare in our population. The use of alcohol for medicinal purposes was associated with more frequent use but the amount used on a typical day does not differ between the groups. Thus, it seems that older adults use alcohol for medicinal purposes typically in small quantities. However, use of alcohol for medicinal purposes was associated with forgetting to take medicines, relatives' worries, as well as falls and fractures. Older people may have misbelieves about the medicinal use of alcohol that leads them to regular use of alcohol. Older adults have simultaneously many chronic conditions and take medicines that may have interactions with alcohol. They may be unaware of the risky consequences of using both alcohol and medicines. Our findings emphasise the need for healthcare professionals to educate and monitor older adults concerning alcohol consumption and use of medication. Older adults, especially very old age groups, use alcohol as a medicine. Older adults used alcohol for cardiovascular diseases, sleep disturbances, common cold and indigestion. Older adults have many chronic conditions for which they take medicines that may have interactions with alcohol. This work was supported by the Yrjö Jahnsson Foundation We thank statistician Hannu Kautiainen for his kind help.