The Combined Effects of Drinking and Comorbidities on Mortality in Elders

Mortality associated with risky drinking has not been appreciated in older adults, possibly because their comorbidities mask alcohol’s effects. This study assessed the combined influence of drinking and comorbidities on 20-year mortality in 4691 adults aged 60 and older who participated in a national health and nutrition study.

During follow-up, 2673 subjects died. The prevalence of risky drinking at baseline was 10% (n=425). Risky drinking was defined as follows:

• For subjects without comorbidities:
  3 drinks per day >=4 times per week or >= 4 drinks per day
• For subjects with gout or an anxiety disorder or who were taking medications for nerves, insomnia, seizures, allergies, indigestion, or pain: 2–3 drinks per day >= 2 times per week or >= 4 drinks per day
• For subjects with hepatitis or ulcer disease: Any alcohol use

Most risky drinkers (69%) were classified as such because of their combined alcohol use and comorbidities (and not solely because of the amount they consumed). In adjusted analyses, the risk of mortality was higher in risky drinkers and abstainers than in nonrisky drinkers (hazard ratio [HR] 1.1 for both; borderline significant findings).

Comments:

In this study, comorbidity rather than amounts consumed defined most risky drinking in older adults. Clinicians should consider recommending lower drinking limits to their older patients with specific comorbidities to reduce mortality risk.

Joseph Conigliaro, MD, MPH

Reference:

Moore AA, Giuli L, Gould R, et al. Alcohol use, comorbidity, and mortality. J Am Geriatr Soc. 2006;54(5):757–762.