Late-life and life history predictors of older adults’ high-risk alcohol consumption and drinking problems

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Abstract

Aims

This prospective, longitudinal study focused on late-life and life history predictors of high-risk alcohol consumption and drinking problems during a 20-year interval as adults matured from age 55–65 to 75–85.

Design, setting, participants

A sample of older community residents (N = 719) who had consumed alcohol in the past year or shortly before was surveyed at baseline and 10 and 20 years later.

Measurements

At each contact point, participants completed an inventory that assessed their alcohol consumption, drinking problems, and personal and life context factors. Participants also provided information about their life history of drinking and help-seeking.

Results

Older adults who, at baseline, had more friends who approved of drinking, relied on substances for tension reduction, and had more financial resources were more likely to engage in high-risk alcohol consumption and to incur drinking problems at 10- and 20-year follow-ups. With respect to life history factors, drinking problems by age 50 were associated with a higher likelihood of late-life high-risk alcohol consumption and drinking problems; having tried to cut down on drinking and participation in Alcoholics Anonymous were associated with a lower likelihood of high-risk consumption and problems.

Conclusion

Specific late-life and life history factors can identify older adults likely to engage in excessive alcohol consumption 10 and 20 years later. Targeted screening that considers current alcohol consumption and life context, and history of drinking problems and help-seeking, could help identify older adults at higher risk for excessive or problematic drinking.

Introduction

In general, older adults’ alcohol consumption tends to decline with age; nonetheless a significant number of older individuals engage in high-risk alcohol consumption that exceeds current US national guidelines and recommendations (Breslow and Smothers, 2004, Zhang et al., 2008). However, we still know relatively little about the extent to which late-life personal and social factors predict high-risk alcohol consumption and drinking problems among adults as they mature from age 55–65 to 75–85. In addition, more information is needed about how well life history indices of drinking and help-seeking predict excessive alcohol consumption and associated problems among older adults, and whether late-life indices add to or interact with the prediction obtained from life history factors.

We focus on these issues here by describing changes in high-risk alcohol consumption and drinking problems among older adults over a 20-year interval from age 55–65 to 75–85. We then address four main questions. (1) What theory-based, late-life factors predict high-risk alcohol consumption and drinking problems among older adults? (2) How well do life history factors, such as heavy drinking prior to age 50 and help-seeking, predict late-life alcohol consumption and drinking problems? (3) Do late-life factors add to the prediction of late-life drinking behavior over and above the prediction afforded by life history factors? (4) Are there interactions between late-life and life history predictors of late-life drinking patterns, such that, for example, a history of drinking problems alters the likelihood that late-life financial resources will be associated with high-risk consumption or drinking problems 10 or 20 years later.

Several theories, including social learning, stress and coping, and social control theory, have been used to identify personal and social factors associated with the development and maintenance of excessive alcohol consumption and drinking problems among young and middle-age adults (Moos, 2007). With few exceptions (Preston and Goodfellow, 2006), these theories have not been applied to consider alcohol-related behavior among older adults. Here, we consider potential predictors of late-life high-risk alcohol consumption and drinking problems associated with these three theories. We expect to find developmental continuity in that predictors identified as important among young and middle-age adults will also emerge as salient among older adults.

According to social learning theory, alcohol use develops and is maintained by specific attitudes and behaviors of an individual's social network members, especially family members and friends. In essence, the theory proposes that engagement in social and leisure activities with family members and friends who approve of and model drinking behavior is a salient predictor of alcohol use and misuse (Bandura, 1997, Maisto et al., 1999). There is extensive evidence in support of these processes among young and middle-age adults (Bullers et al., 2001, McCrady, 2004, Mohr et al., 2001).

Among older adults, cross-sectional studies indicate that participation in social activities and drinking for social reasons is associated with more alcohol consumption (Busby et al., 1988, Graham et al., 1996). In addition, family members and friends who drink and espouse positive drinking norms tend to be linked to more frequent and heavier concurrent alcohol consumption among older adults (Akers et al., 1989, Stall, 1986). Among older adult couples, husbands and wives whose partners drink consume alcohol more frequently and in larger amounts than do those with abstinent partners (Graham and Braun, 1999). We assess two variables relevant to social learning theory: participation in social activities and friends’ approval of drinking.

Stress and coping theory posits that problematic life circumstances may arouse distress and alienation, which may eventually lead to coping-based alcohol use among individuals who lack more adaptive coping skills and who try to avoid facing problems or negative affect. For such individuals, alcohol use can be a form of avoidance coping that involves self-medication to reduce anxiety and depression (Moos, 2007). Among mixed-age adults, more reliance on stress-related drinking to cope with depression and distress and on general avoidance coping is associated with more alcohol consumption and drinking problems (Carpenter and Hasin, 1999, Holahan et al., 2003, Trim et al., 2008). Comparable findings have been identified among older adults, many of whom cite personal effects reasons for drinking, including for relief of anxiety or pain (Brennan et al., 2005, Graham et al., 1996, Lemke and Moos, 2003). Here, we assess both reliance on substances to reduce tension and general avoidance coping.

Social control theory assumes that a network of social bonds, such as with family, friends, and religion, serves an important regulatory function that motivates individuals to engage in socially appropriate behavior. When such bonds are weak or absent, individuals are less likely to adhere to accepted standards and tend to engage in risky behavior, such as excessive use of alcohol (Rook et al., 1990). According to the theory, strong ties to religion provide an especially important bond and, in fact, have been consistently associated with less alcohol consumption among young and middle-age adults (Booth et al., 2004, Mason and Windle, 2001, Pardini et al., 2000). Consistent with these findings, Krause (1991) noted that religious involvement was associated with less concurrent alcohol consumption among older adults.

Financial resources generally reflect some social bonding and, as such, might be associated with fewer drinking problems. This prediction is also consistent with behavior economic theory, which posits that financial resources encompass rewards that can substitute for the reinforcements associated with alcohol use (Bickel and Vuchinich, 2000). However, financial resources also are an enabling factor for the purchase of alcoholic beverages and thus might be associated with more alcohol consumption. Studies of mixed-age individuals tend to show inconsistent findings; both fewer (Droomers et al., 1999, Moos and Moos, 2007) and more (Kunz and Graham, 1998, Veenstra et al., 2006) financial resources have been linked with higher alcohol consumption. Among older adults, there is some evidence of a connection between more financial resources and more alcohol consumption (Busby et al., 1988, Stall, 1986). We focus here on religious involvement and financial resources as potential predictors of late-life alcohol consumption and drinking problems.

In addition to these theory-based predictors, we consider baseline alcohol consumption in late-life as a predictor of subsequent excessive consumption and drinking problems. Although overall average levels of consumption decline with age, there is some stability in the amount of alcohol consumption among both mixed-age and older adults (Kerr et al., 2002). In addition, higher alcohol intake has been associated with an elevated likelihood of drinking problems among both mixed-age (Dawson, 2000, Midanik, 1999) and older adults (Chermack et al., 1996, Hilton, 1987, Walton et al., 2000). However, relatively little is known about how well late-life consumption predicts high-risk use of alcohol or drinking problems over subsequent 10- or 20-year intervals in late-life.

Several studies have obtained lifetime histories of individuals’ alcohol consumption and alcohol-related consequences (Jacob et al., 2006, Lemmens, 1998, Russell et al., 1997), but we are unaware of research using information about the development and course of drinking through middle-age to predict late-life drinking patterns. Individuals who have engaged in moderate to heavy drinking or have incurred drinking problems earlier in life might be expected to have a higher likelihood of late–late high-risk alcohol consumption and drinking problems. However, due to the stigma associated with heavy drinking and drinking problems, many of these individuals may successfully reduce their drinking either by their own efforts or by obtaining help (Schutte et al., 2006).

With respect to help-seeking, there is substantial evidence that participation in treatment and self-help groups, such as AA, has beneficial effects for younger and middle-age adults (Finney et al., 2007, Moos, 2008). It is less clear whether the benefits of having received these sources of help might still be evident in old age. We focus here on whether older adults who were advised to and tried to cut down on their drinking, and those who received informal help from family members and friends or participated in professional treatment or AA, are less likely to engage in high-risk alcohol consumptions or incur drinking problems in late-life.

In prior work based on earlier follow-ups of the overall sample on which we focus here, we found that friends’ approval of drinking, avoidance coping, and prior drinking problems were associated with a higher likelihood of subsequent drinking problems, whereas having obtained help from family members and friends was associated with a lower likelihood of subsequent problems (Moos et al., 2004). We extend this work here by focusing on the associations between theory-based personal and social late-life factors, life history of drinking and help-seeking, and high-risk alcohol consumption and drinking problems at 10- and 20-year follow-ups. Because we thought that a history of heavier or problem drinking might potentiate the effect of current life context factors, we also considered interactions between late-life and these life history factors in predicting late-life high-risk alcohol consumption and drinking problems.

Section snippets

Participants

A sample of 1884 late-middle-aged community residents (55–65 years old at baseline) was recruited to participate in a study of late-life alcohol consumption and drinking problems and the influence of life history factors on these domains. The sample was composed of individuals who had consumed alcohol in the past year or shortly before and had had outpatient contact with a health care facility within the last 3 years. The sample was comparable to similarly aged community samples with regard to

Changes in alcohol consumption and drinking problems

There was a decline in the proportion of individuals who consumed alcohol in excess of 3 drinks per day or 14 drinks per week and in the proportion who reported drinking problems (Table 1). Men were more likely to engage in high-risk alcohol consumption and to experience drinking problems; however, the decline in these indices over the 20 years was comparable for women and men. As expected, high-risk alcohol consumption and drinking problems were moderately correlated (rs = .44 and .32 at the 10-

Discussion

Although our sample of older adults reduced their drinking over the 20 years as they matured from age 55–65 to 75–85, many individuals continued to consume alcohol in excess of 3 drinks per day or 14 drinks per week, which exceeds recommended drinking guidelines for older adults (American Geriatrics Society, 2003, NIAAA, 2007). In fact, between 10% and 30% of participants still engaged in high-risk drinking and/or experienced drinking problems at the 20-year follow-up when they were 75–85 years

Conflict of interest

All authors declare that they have no conflicts of interest.

Role of funding source

Funding for this study was provided by NIAAA grants AA06699 and AA15685 and by Department of Veterans Affairs Health Services Research and Development Service funds. The funding agencies had no further role in study design, in the collection, analysis and interpretation of data; in the writing of the report; or in the decision to submit the paper for publication.

Contributors

Rudolf Moos, Penny Brennan, and Kathleen Schutte designed the study and supervised the data collection. Rudolf Moos managed the literature searches and summaries of prior related work. Bernice Moos set up the data files and conducted the statistical analyses. Rudolf Moos wrote the first draft of the manuscript. All authors contributed to and approved the final manuscript.

Acknowledgements

We thank Carrie Brecht, Lucy Horton, and Sarah Strite for their help in obtaining the 20-year follow-up data. The views expressed here are the authors’ own and do not necessarily represent the views of the Department of Veterans Affairs or the United States government.

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