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Older adults who binge drink face an increased mortality risk

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Those who engage in binge drinking have more than two times higher odds of 20-year mortality

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Many studies have highlighted the purported association between moderate drinking and reduced mortality. However, these studies have concentrated strongly on average consumption, a measure that masks diverse, underlying drinking patterns such as weekend heavy episodic or binge drinking.

Dr. Charles J. Holahan, PhD, professor of psychology at The University of Texas at Austin and corresponding author of this study along with colleagues examined the association between episodic heavy drinking and total mortality among moderate-drinking older adults.

For this study, researchers used data from a larger project examining late-life patterns of alcohol consumption and drinking problems. At baseline, the sample was comprised of 446 adults aged 55 to 65; 74 moderate drinkers who engaged in episodic heavy drinking and 372 regular moderate drinkers. Researchers controlled fora broad set of socio-demographic, behavioral and health status covariates. Death across a 20-year follow-up period was confirmed primarily by death certificate.

The results showed moderate drinkers who engaged in episodic heavy drinking had more than two times higher odds of 20-year mortality in comparison with regular moderate drinkers.

In their conclusion the researchers write “Among older moderate drinkers, those who engage in episodic heavy drinking show significantly increased total mortality risk compared to regular moderate drinkers. Episodic heavy drinking—even when average consumption remains moderate—is a significant public health concern.”

According to Dr. Holahan, "Binge drinking is increasingly being recognized as a significant public health concern.” “In fact, the U.S. Centers for Disease Control recently concluded that binge drinking is 'a bigger problem than previously thought.' Ours is one of the first studies to focus explicitly on an older population in examining binge drinking among, on average, moderate drinkers."

Dr. Timothy Naimi, MD, MPH, associate professor of medicine and alcohol researcher at Boston Medical Center at Boston University, added "Some of the greater attention to binge drinking is due to increases in binge drinking since the mid-1990s, but perhaps more because of growing recognition of the importance of patterns: it's not just how much you drink but how you drink.”

"All told, excessive alcohol use causes about 80,000 deaths annually in the US, and many of these deaths are among youth and young and working-age adults."

The findings highlight the importance of focusing on drinking patterns, as well as absolute amounts of ethanol consumed, as predictors of health and mortality outcomes among older adults.

"We found that among older adults, those who engage in heavy episodic drinking – even when average consumption is moderate – show significantly increased total mortality risk compared to regular moderate drinkers," said Holahan. "These findings demonstrate that, among older adults, drinking patterns need to be addressed along with overall consumption in order to understand alcohol's health effects."

Dr. Naimi adds "This is a crucial point," since approximately a quarter of 'moderate' drinkers report binge drinking, and most folks in the US don't typically drink in an 'average' way or on a daily basis. Clinicians should understand that even among those with apparently modest average consumption, a number of these folks may be drinking in risky ways."

Dr. Holahan and Naimi remarked that these findings may pose special health concerns for these older adults, even though binge drinking is damaging at any age.

Binge drinking concentrates alcohol's toxicity and is linked to mortality by damaging body organs and increasing accident risk.” "Binge drinking may be additionally risky for older adults due to aging-related elevations in comorbidities as well as medication use,” stated Dr. Holahan.

Dr. Naimi agreed, "Binge drinking is dangerous and many bad things have happened to drinkers or to others -- car accidents, fights, injuries, domestic violence, sexual assaults -- on the basis of binge drinking even if it is 'atypical' of how they drink and/or among those who are not alcoholic.”

"While it is less common among those who are older than among youth and younger adults, it may carry as much or more risk on a per-person basis as older individuals have less physiologic reserves, for example,” he said.

In closing Dr. Holahan comments "The take-home message here for readers is that binge drinking is a significant public health problem that is frequent among middle-aged and older adults.”

Results will be published in the May 2014 online-only issue of Alcoholism: Clinical & Experimental Research and are currently available at Early View.

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