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ORIGINAL ARTICLE
Year : 2023 | Volume
: 50
| Issue : 1 | Page : 97-101
“Pattern of alcohol use in elderly patients in a primary health center in Goa”
Lisa Merlyn Rodrigues, Vanita G. Pinto Da Silva
Department of Community Medicine, Goa Medical College, Bambolim, Goa, India
Correspondence Address:
Lisa Merlyn Rodrigues
House No. 1752/1, Vasvaddo, Vaddie, Benaulim, Salcete - 403 716, Goa
India
Source of Support: None, Conflict of Interest: None
CheckDOI: 10.4103/jss.jss_197_22
Background: The portrayal of alcohol as necessary for a vibrant social life has diverted attention from the harms of alcohol use. There is no safe level of alcohol consumption. Studies focusing on problems associated with alcohol use in the elderly are limited. Aim: The aim of this study is to determine the pattern of alcohol use in the study population and to study some factors associated with alcohol use in the study population. Methods: This was a cross-sectional, hospital-based study conducted in the Rural Health and Training Center at Mandur, Goa, India, over 3 months from February 2022 to April 2022 in persons ≥65 years recruited using systematic random sampling method. Results: Out of 207 participants, 114 (55%) were females and 93 (45%) were males. The mean (±standard deviation) age of the study population was 72.73 ± 7.87 years. The total proportion of alcohol use in the study population was 35.3%. Among those who consumed alcohol, 64.4% were current users and 35.6% were former users. Among the current users, 61.7% were low-risk drinkers, 21.3% were at-risk drinkers, and 10.6% indulged in harmful and hazardous drinking, whereas 6.4% had possible dependence on alcohol. Conclusions: Increase in aging populations implies that the absolute number of older people with alcohol use is on the increase. Hence, health services need to cater to alcohol screening and treatment methods and services in the elderly population.
Keywords: Alcohol use disorders, elderly alcohol users, rural, factors
The portrayal of alcohol as necessary for a vibrant social life has diverted attention from the harms of alcohol use. There is no safe level of alcohol consumption, and any level of drinking can contribute to the loss of a healthy life.[1] Alcohol use is not uncommon among the elderly and remains underdetected.[2] Increase in aging populations implies that the absolute number of older people with alcohol use is on the increase.[3] Studies showed the prevalence of alcohol varying between 17.1% and 21.83% in the elderly age group, with prevalence varying from 16.3%–19.30% in men and 0.8%–2.53% in women.[4],[5]
An analysis of morbidity patterns by age clearly indicates that the elderly experience a greater burden of ailments, which will be exacerbated by alcohol use.[6] Alcohol use is also a major risk factor for cancer, digestive diseases, intentional and unintentional injuries, and several infectious diseases. Furthermore, age-related physiologic, biologic, and psychosocial issues pose unique challenges in the management of alcohol use in the elderly. Further, it may not come to clinical attention. Frequently, some sociodemographic factors have been observed to play a role in alcohol use, as well as complicate medical morbidity. Many elderly people do not disclose information about their drinking because they are ashamed of doing so at their age.[2] Many are isolated from their family members with minimal social networks. With a projected increase in the aging population from 7.5% in 2010 to 11.1% in 2025,[7] it is increasingly important that older adults are supported to maintain and improve their physical, mental, and social health and well-being and to minimize the risk of noncommunicable diseases.
Age-related changes in older adults who consume alcohol place them at an additional risk of contracting diseases. Older adults have increased sensitivity to the effects of alcohol because they typically metabolize alcohol more slowly,[8] at the same time, it tends to complicate preexisting medical conditions, increase the prevalence of falls and exaggerate other health conditions. Cessation of alcohol use can still slow down the incidence of noncommunicable diseases and prevent substance-induced problems.
Studies investigating the use of alcohol in the elderly are limited; however, studies focusing on the elderly are comparatively infrequent. Hence, this study was undertaken with the aim of studying the pattern of alcohol use and some of the factors associated with alcohol use among elderly population in a rural area in Goa, India.
Aim
To determine the pattern of alcohol use in the study populationTo study some factors associated with alcohol use in the study population. MethodsStudy setting and study population
A hospital-based cross-sectional study was conducted in the Rural Health and Training Center in Mandur, Goa. The study duration was for a period of 3 months (February–April 2022).
Elderly persons aged 65 years and above, attending Rural Health and Training Center, Mandur, Goa, were recruited in the study. Elderly persons, with severe visual and hearing impairment, or who were suffering from any acute illness at the time of the study, were excluded from the study. Informed consent was taken from the study participants after explaining the purpose of the study. The approval of the institutional ethics committee was taken for conducting this study.
Sample size estimation and sampling strategy
The sample size was estimated to be 207 which was calculated on the expected proportion of alcohol consumption of 16% in a study done by Goswami et al.[4] The recruitment of the study participants was done by systematic random sampling method.
Data tools
Data tools used a semi-structured questionnaire and the Alcohol Use Disorder Identification Test (AUDIT Questionnaire)[9] by the WHO.
Data collection
Data collection was done using a semi-structured questionnaire administered by face-to-face interview to collect sociodemographic details and associated factors such as chronic conditions and history of smoking. The AUDIT questionnaire was used to study the pattern of alcohol use in the study participants. The AUDIT questionnaire consists of a set of 10 questions. Each of the questions has a set of responses to choose from, and each response has a score ranging from 0 to 4. All response scores were then added at the end. Both questionnaires were administered in the local language.
Case definitions
Elderly
It includes adults aged 65 years and above
Alcohol use
The following operations definitions were used to study alcohol use:
Ever users of alcohol
Ever users of alcohol include both current users and former users.
Current alcohol users
Current alcohol users have consumed one or more standard drinks of alcohol at least once during the past 1 year preceding the time of the interview.[10]
Former alcohol users
Former alcohol users have consumed one or more standard drink of alcohol at least once during their lifetime but had not done so for 1 year preceding the survey.[10]
Never users of alcohol
Never users of alcohol have never consumed alcohol in his lifetime.
Pattern of alcohol use
Once the scores were obtained after administering the AUDIT questionnaire, they were divided into four categories or zones as low-risk drinkers (zone 1 score 0–7), at-risk drinkers (zone 2 score 8–15), harmful and hazardous drinking (zone 3 score 16–19), and possible dependence on alcohol (zone 4 score >20).
Hazardous drinking
It is a pattern of alcohol consumption that increases the risk of harmful consequences for the user or others.
Harmful use
It is alcohol consumption that results in consequences to physical and mental health.
Alcohol dependence
Alcohol dependence is a cluster of behavioral, cognitive, and physiological phenomena that may develop after repeated alcohol use.
Chronic diseases
The chronic diseases included diabetes mellitus, hypertension, chronic obstructive pulmonary disease, asthma, arthritis, cancer, ischemic heart disease, and psychiatric disorders.
Statistical analysis
Results were summarized as mean, standard deviation, and proportions. The odds ratio was calculated to find the association with sociodemographic variables. Data processing and statistical analysis were done using the IBM Corp. (2013) IBM SPSS Statistics for Windows, Version 22.0. IBM Corp., Armonk, New York, USA.
ResultsSociodemographic profile
A total of 207 elderly persons were recruited in the present study. As shown in [Table 1], the majority of the study participants were females 114 (55%) and 93 (45%) were males.
Table 1: Distribution of study participants according to sociodemographic characteristicsThe highest proportion of males (50.5%) was found in the age group of 65–69 years and the lowest proportion of males (21.5%) was found in the age group of >80 years. The highest proportion of females (49.2%) was found in the age group of 70–80 years and the lowest proportion of females (8.7%) was found in the age group of >80 years. The mean age of the study population was found to be 72.73 ± 7.87 years.
A majority of the study population, i.e., 61.9% were found to be Hindus, 28.9% were Catholic, and 9.2% were Muslims.
It was observed that the highest proportion of the study population (23.2%) had primary school education and lowest proportion of the study population was illiterate (13.5%).
Almost half of the study population was married 109 (52.6%), 72 (34.8%) were separated, and 26 (12.5%) were unmarried. It was observed that the highest proportion of individuals (29.5%) belonged to class two socioeconomic class, whereas the lowest proportion of individuals (7.7%) belonged to lower socioeconomic class, i.e., class five according to the modified BG Prasad classification 2021.[11] A majority of the study participants, 161 (77.8%) were living with family members, whereas 46 (22.2%) of the study participants lived alone.
Pattern of alcohol use
As shown in [Figure 1], it was observed that 61.7% of current alcohol users were low-risk drinkers, 21.3% were at-risk drinkers, and 10.6% indulged in harmful and hazardous drinking, whereas 6.4% had possible dependence on alcohol.
Factors associated with alcohol use
As portrayed in [Table 2], in the current study, the risk factors were, male gender (odds ratio [OR] = 21.84), Class 1 (OR = 5.7) and Class 2 (OR = 4.5) socioeconomic scale, and smoking (OR = 4.2).
DiscussionIn the current study, the proportion of alcohol in the study population was found to be 35.2%. Alcohol consumption was seen in 63 (67.7%) of the men compared to 10 (8.8%) of the women in the present study. Similar findings were present in a study by Udayar et al[12],[13] where alcohol use was seen in 28.7% of the men compared with 0.9% of the women and Swaddiwidhipong et al.[14] where men also had a higher proportion of current alcohol drinkers (20.3%) than women (5.3%). The proportion of alcohol consumption declined with the increase in age (maximum in the 65–69 years age group and minimum in more than the 80 years group) which was similar to the findings of Goswami et al.[4]
It was observed that 61.7% of current alcohol users were low-risk drinkers, 21.3% were at-risk drinkers, and 10.6% indulged in harmful and hazardous drinking, whereas 6.4% had possible dependence on alcohol. According to the data obtained, most of the study population who were current drinkers, were at low risk, whereas those who were at risk of possible dependence were the least. A study conducted by Fink et al. had similar findings wherein 11% of participants were harmful drinkers and 35% were hazardous drinkers. Harmful drinking was more common in men than in women and persons younger than 75 than those aged 75 and older. Similar proportions of men and women and younger and older age groups were hazardous drinkers.[15] Another study conducted by Clausen et al. had similar findings wherein 42% were lifetime abstainers of alcohol, 24% were former drinkers, 22% were moderate drinkers (AUDIT 7 and below), and 12% were hazardous drinkers (AUDIT 8 and above).[16]
In the current study, the risk factors were male gender (OR = 21.84), Class 1 (OR = 5.7) and Class 2 (OR = 4.5) socioeconomic scale, and smoking (OR = 4.2).
ConclusionsIncrease in aging populations implies that the absolute number of older people with alcohol use is on the increase. Hence, health services need to cater to alcohol screening and treatment methods and services in the elderly population.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
References
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