Fewer Than Half of Older Adults Discuss Alcohol with Providers

More than half 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, according to a new study by Columbia University Mailman School of Public Health researchers. In particular, older women 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.

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.

“Older adults are at high risk for the harms of alcohol use, especially for those with existing chronic disease and who take prescribed medications,” says Pia Mauro, PhD, assistant professor of epidemiology at Columbia Mailman School 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.”

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. The sample included 9,663 adults ages 65 and older. 

Among older adults who used alcohol and encountered the healthcare system in the past year, 26 percent reported having no alcohol screening or discussions of any kind, 28 percent reported alcohol screenings only, and 46 percent reported having discussions with providers. 

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 (10.0 percent versus 7.0 percent), were advised to cut down on drinking (7.0 percent versus 3.0 percent) or were offered information about alcohol treatment (2.0 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,” says Benjamin Han, MD, MPH, assistant professor in the Division of Geriatrics, Gerontology, and Palliative Care at UC San Diego, and senior author.

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. “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,” she says.

A co-author is Melanie Askari, Columbia Mailman School of Public Health.

This work was supported by the National Institutes of Health/National Institute on Drug Abuse (grants DA045224, DA043651).