Drink to your health?
According to Dr. Alison Moore, men with certain conditions or on certain medications might want to reconsider

After two major studies published in the late 1990s suggested that moderate consumption of alcohol in middle and old age reduced deaths from vascular disease by one-third, many older Americans felt a certain freedom to enjoy one or two drinks a day. But a recent study led by 1998 Beeson Scholar Alison Moore, M.D., associate professor of geriatric medicine at the David Geffen School of Medicine at UCLA, has found that older men who drink as few as two drinks twice a week, and also have certain comorbidities, have higher death rates than men who drink less or don’t have similar comorbidities. Who’s most at risk? Men who have diseases that could be worsened by alcohol or who take medications that could interact with alcohol.

A new look at old data
The data sources for Moore ’s study were the 1971–74 National Health and Nutrition Examination Survey I (NHANES I) and the 1992 NHANES Epidemiologic Follow-up Study (NHEFS). NHANES I originally included approximately 32,000 persons between one and 74 years of age. Although a major emphasis of the survey was on nutrition and some limited aspects of health, a subset of 3,854 persons, aged 25 to 74, received a more detailed health examination.

Those 3,854 individuals were studied further in the NHEFS, a series of follow-up studies conducted throughout the 1980s and 1990s. The NHEFS was jointly initiated by the National Center for Health Statistics and the National Institute on Aging in collaboration with other agencies of the Public Health Service. The NHEFS was designed to investigate the relationships between clinical, nutritional, and behavioral factors assessed in NHANES I and subsequent morbidity, mortality, and hospital utilization, as well as changes in risk factors, functional limitation, and institutionalization.

By studying results from NHANES I and the NHEFS, Moore and her team were able to identify 4,691 participants aged 60 and older who provided data on alcohol use. Ten percent of these participants were identified as at-risk drinkers. An at-risk drinker was defined as someone who consumes more than two drinks a couple of times a week and has certain comorbidities, such as having gout or anxiety or taking a medication for pain. Eighteen percent of men and 5 percent of women were deemed at-risk drinkers.

The researchers found that 2,673 people (1,379 men and 1,294 women) from the initial NHANES I survey had died by the time of the follow-up study approximately 20 years later. Of those who abstained from drinking, 65 percent (76 percent of men and 60 percent of women) had died. Of the drinkers considered to be not-at-risk, 62 percent had died (68 percent of men, 56 percent of women), and of the drinkers considered to be at-risk, 70 percent had died (77 percent of men, 49 percent of women).

In analyses including men and women, at-risk drinkers had a 12 percent increased risk for death and abstainers had an 8 percent increased risk for death as compared to not-at-risk drinkers. In analyses done separately for men and women, men at-risk drinkers had a 20 percent increased risk of death as compared to not-at-risk drinkers, while abstainers had no increase in risk for death. Among women, neither at-risk drinkers nor abstainers had increased risks for death compared to not-at-risk drinkers, although it should be noted that only 89 women in the sample were considered at-risk drinkers versus 336 men.

Revised recommendations
While other studies have investigated the effects of alcohol consumption, this is the first large, population-based study of older adults examining the mortality risks of alcohol use and comorbidity.

“No other study has specifically looked at the interaction of alcohol use and conditions or medications that may be unsafe with even moderate amounts of alcohol use,” Moore says. “This study shows that while moderate alcohol use may be fine for people who don’t have other conditions that could be worsened by the use of alcohol, such alcohol use may not be fine if you take common medications for sleep, or for arthritis pain, or have depression, or have some gastrointestinal condition.”

And that, suggests Moore , is reason enough for physicians to revise their recommendations about alcohol consumption among older patients. Specifically, older adults with specific comorbidities should reduce their threshold of alcohol use to reduce mortality risks.