Psychiatry - Theses
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ItemA population-based study of alcohol use in elderly men: associations with physical and mental health( 2012)Considerable attention has been paid to the prevalence and outcomes of alcohol use disorders in both in population-based and clinical samples, and also to the harms associated with alcohol intake in young adults. However less attention has been paid to alcohol consumption in elderly men. The aims of this population-based study were to investigate the patterns of alcohol consumption and the associations between different levels of alcohol intake and demographic, lifestyle, physical and mental health outcomes in a representative sample of elderly men. Five hundred and fifty five participants aged at least 65 years and enrolled in the Geelong Osteoporosis Study reported their usual alcohol consumption for the prior 12-months, had their BMD measured and completed a comprehensive range of medical and lifestyle assessments. Alcohol consumption was common, the majority (48.7%) consumed alcohol moderately (≤2 drinks/day), with a further 19.7% consuming 3-4 drinks and 13.5% consuming ≥5 drinks/day. Almost one in five elderly men in this sample were a non-drinker at the time of assessment. The alcohol consumption groups were compared on demographic and lifestyle variables, and also on key physical and mental health outcomes. The median alcohol consumption increased with increasing socio-economic status. The heaviest alcohol consumption groups were more likely to report current or past cigarette smoking and were also more likely to have low leisure-time physical activity levels in age adjusted models (OR=1.74 95% CI 1.01-3.00), and more likely to have impaired mobility as measured by the Timed Up & Go test (OR=3.01 95% CI 1.41-6.43) when compared to moderate alcohol consumers. Current non-drinkers were more likely to have low leisure-time physical activity levels (OR=1.75 95% CI 1.05-2.91) and were less likely to be current participant in sport (OR=0.52 95% CI 0.29-0.94) than moderate alcohol consumers, independently of age, cigarette smoking and current use of five or more medications. In comparison to non-drinkers, consumers of ≥5 drinks/day had mean differences in adiposity of +4.8% (BMI), +20.1% (FMI), +5.0% (waist circumference), +15.2% (%body fat), +5.3% (% trunk fat) and had a mean difference in lean tissue mass of -5.0%. Furthermore, they had a 2.8-fold increased risk of being classified as obese according to BMI (≥30 kg/m2) and a 3.4-fold increased risk of having a waist circumference of at least 102 cm. While the groups differed in total energy intake, they did not differ in energy intake obtained from food suggesting unregulated supplementation of energy intake from alcohol. Aside from a difference at the mid-forearm site BMD was not associated with alcohol consumption, however bone quality as measured by quantitative ultrasound at the heel decreased with increasing alcohol consumption. Overall, 14.8% of this sample met criteria for a lifetime history of a mental illness, and 3.1% were identified as having a current psychiatric illness, most commonly major depressive disorder. Non-drinkers (OR=2.58 95% CI 1.20-5.56) and consumers of ≥3 drinks/day (OR=1.73 95% CI 0.85-3.51) were more likely to have a lifetime history of any psychiatric illness than moderate alcohol consumers after adjustment for age and mobility. There was a low prevalence of alcohol use disorders in this sample, 2.6% for a lifetime history and 0.8% for a current disorder. One third of elderly men currently drink at a level in excess of the Australian government recommendations for safe alcohol consumption, which in combination with medical comorbidities and high levels of medication use places this group at increased risk of harm. Furthermore, both heavy alcohol consumption and current non-drinking was associated with negative physical and mental health outcomes, this highlights the importance of routinely screening for alcohol consumption within the elderly, and extending the investigation into other important correlates when indicated. Although causality cannot be inferred, these findings provide an insight into the association between alcohol intake, lifestyle and physical and mental health.