Fewer than half of older adults discuss alcohol with providers

COLUMBIA UNIVERSITY’S MAILMAN SCHOOL OF PUBLIC HEALTH

Over one-quarter of U.S. adults age 65 and older who used alcohol and had a healthcare visit in the past year were not asked about their alcohol use with their healthcare providers, according to a new study by Columbia University Mailman School of Public Health. Older women in particular who have distinct risks from alcohol were less likely than older men to discuss their alcohol use. The study is among the first to use a large nationally representative sample of older adults to capture both alcohol screening and the content of alcohol discussions with providers. The results are published in the journal Alcoholism: Clinical & Experimental Research.

Among older adults who used alcohol and encountered the healthcare system in the past year, 25 percent of men and 27 percent of women reported having no alcohol screening or discussions of any kind. Older adults are at particular risk from the harms of alcohol use given physiological changes in aging that can increase sensitivity to alcohol.

“Older adults are at high risk for the harms of alcohol use, especially for those with existing chronic disease and who take prescribed medications,” said Pia Mauro, Ph.D., assistant professor of epidemiology at Columbia Mailman School of Public Health, and the study’s lead author. “Alcohol use can therefore lead to negative consequences and complicate the management of chronic medical diseases among older adults, making discussions about alcohol with providers particularly important in this population.”

Fewer than half of older alcohol-using adults reported any discussion about their alcohol use with a provider, indicating missed opportunities in reducing or preventing alcohol-related adverse outcomes in this population.

The researchers used data on adults age 65 and older from the 2015-2019 National Survey on Drug Use and Health who reported alcohol use and a past-year healthcare visit for any reason to estimate alcohol screening and discussions with providers, focusing on gender differences. The sample included 9,663 U.S. adults ages 65 and older. 

Of those with past-year alcohol use and a past-year healthcare encounter, 49 percent were male and 51 percent were female. Overall, 54 percent of older adults who used alcohol did not discuss this alcohol use with any provider (49 percent of the men; 58 percent of the women). Among participants who had a discussion about alcohol use with their provider, a higher proportion of men than women reported being asked about drinking problems (10 percent versus 7 percent), were advised to cut down on drinking (7 percent versus 3 percent), or were offered information about alcohol treatment (2 percent versus 0.7 percent).

Older men who encountered the healthcare system and reported past-year alcohol use had a higher prevalence of past-month binge drinking than older women (22 percent versus 14 percent)  and past-year alcohol use disorder (4.5 percent versus 2 percent). Chronic diseases were common in this study sample: 74 percent had any chronic disease, 42 percent had high blood pressure, 28 percent had heart disease, 19 percent with cancer, and 18 percent with diabetes. Over 35 percent had two or more chronic diseases. 

“It is important that older adults understand that aging itself can lead to an increased sensitivity to alcohol and that certain chronic diseases can be exacerbated by alcohol use,” said Benjamin Han, an assistant professor in the Division of Geriatrics, Gerontology, and Palliative Care at UC San Diego, and senior author. The National Institute on Alcohol Abuse and Alcoholism now recommends up to one drink per day for women and up to two drinks per day for men, while some adults who take certain prescribed medications or have certain medical conditions are advised not to consume alcohol. 

Despite these recommendations, unhealthy alcohol use is increasing among older adults nationally. Therefore, clinicians should, at a minimum, discuss alcohol use with older patients, and especially those with chronic diseases, to inform their clinical care, according to Mauro.

“Our findings of these gender differences call for targeted efforts to increase alcohol use discussions among older adults and their providers,” said Mauro. “Normalizing discussions about alcohol use with providers in a non-judgmental way is an important step to reduce stigma and prevent potential negative health consequences.”