Alcohol use among older adults: Population perspectives on prevalence, correlates, and consequences of drinking in Swedish 70-year-olds

Abstract: Background: Alcohol consumption is a major contributor to global morbidity and mortality, as well as accidents and intentional injuries. Older adults may be particularly susceptible to these negative consequences due to age-related factors that increase vulnerability to the adverse effects of alcohol. The overall aim of this thesis was to investigate alcohol consumption patterns in population-based samples of older adults by examining the prevalence, time trends, associated factors across specific levels of consumption, and the influence of alcohol on all-cause mortality. Method: Data were obtained from the Gothenburg H70 Birth Cohort studies, and study samples (≥70 years of age) included Birth cohorts 1906-07, 1922, 1930, and 1944, with a particular focus on Birth cohort 1944. Results: Paper I outlined the methodology employed during the baseline examination of Birth cohort 1944 conducted between 2014 and 2016, serving as the foundation for all papers in this thesis. Paper II examined changes in alcohol consumption among four birth cohorts of 70-year-olds examined across four decades, showing a significant upward trend in consumption rates, especially among women. Risk consumption increased from 7.4% (16.1% in men, 0.5% in women) in 1976-77 to 34.0% (45.3% in men, 24.3% in women) in 2014-16. In Paper III, substantial discrepancies in sociodemographic, social and health-related factors across different levels of consumption were revealed, with former drinking associated with the most unfavorable set of factors. Further, characteristics varied significantly among 70-year-olds who exceeded low-risk drinking guidelines for older adults. Paper IV investigated the impact of alcohol on all-cause mortality in individuals with a baseline age of 70 years over an 8-year follow-up period. The study also evaluated the combined effect of lifestyle factors on mortality risk using a 7-item risk score. The findings suggested that alcohol consumption has no independent effect on all-cause mortality, but its impact was moderated by physical activity. Moreover, individuals fulfilling criteria for at least five lifestyle risk factors had up to four times higher risk of all-cause mortality. Conclusion: Recent generations of 70-year-olds exhibited higher alcohol consumption rates, yet with few negative consequences, both cross-sectionally and longitudinally. However, consuming alcohol at rates approximately 2.5 times higher than current age-specific guidelines was associated with traditional alcohol-attributable consequences. In addition, a combination of alcohol overconsumption and several unhealthy lifestyle risk factors increased the risk of mortality. The knowledge gained from this thesis could be used to inform public health policies and interventions aimed at reducing harmful alcohol consumption in this particular age group.