Alcohol Consumption, Life Course Transitions and Health in Later - - PowerPoint PPT Presentation

Alcohol Consumption, Life Course Transitions and Health in Later Life

Research Team:

Keele University University College of London Clare Holdsworth, PI Nicola Shelton Marina Mendonça Hynek Pikhart Martin Frisher Cesar de Oliveira

Presentation

• Introduction to the project
• Data and methodology
• Findings:

– Cross-sectional analysis of drinking profiles and health – Longitudinal analysis of drinking quantity and frequency over time

• Policy implications

Research Objectives

• To extend understanding of the diversity of patterns of alcohol

consumption at older ages;

• To identify the socio-demographic dynamics of drinking during later life

and the life events that are associated with changes in drinking behaviours;

• To explore the relationship between drinking and health conditions in

later life;

• To establish the importance of secondary survey data in supporting policy

initiatives directed towards individual health behaviours;

• To inform health policy initiatives on drinking in later life through

identifying the risks associated with excessive drinking (binge drinking or drinking more than recommended weekly amounts) and the relationship between alcohol consumption, health and well-being in later life.

Data & Methodology

ELSA W0 (HSE): Baseline for alcohol variables

• English Longitudinal Study of Ageing (ELSA):
• Practice-informed modeling approach in collaboration with Beth

Johnson Foundation

• Cross-sectional analysis: Association between alcohol consumption

and socio-demographic and health variables

• Longitudinal analysis: Sequencing drinking behaviours over life

course; link between drinking behaviours and health; identifying whether changes in drinking behaviours are associated with individual characteristics

1998 1999 2001 W6 2012/13 W4 2008/9 W5 2010/11 W3 2006/7 W2 2004/5 W1 2002/3

Table 1: Percentage distribution of drinking profiles by gender, wave 0 .

Drinking Variables Drinking Profiles % Respondents wave 0 Drinking Status Quantity of Alcohol Frequency of drinking Men Women Non-drinker Non-Drinker 7 14 Drinker Below Recommended Limits (Men ≤21 units; Women≤ 14 units) Occasional (≤ 4 days) Low Risk: Occasional Drinker 54 64 Daily (≥ 5days) Low Risk: Daily Drinker 12 8 Above Recommended Limits (Men > 21 units Women > 14 unit) Occasional (≤ 4 days) Focal Drinker 7 3 Daily (≥ 5days) Heavy Drinker 20 11

Number of cases = 11205

Figure 1: Percentage Distribution of Drinking profiles by age and gender: wave 0

10 20 30 40 50 60 70 80 Men 45-64 Women 45- 64 Men 65-74 Women 65- 74 Men 75+ Women 75 + Non-drinker Low Risk:Occas. Low risk: Daily Focal Heavy Number of cases = 11205

Figure 2: Percentage of drinking profiles with poor self-rated: wave 0 and wave 5

2 4 6 8 10 12 14 16 18 20

Non-drinker: Always Non-drinker: Stopped drinking Low Risk Steady Focal Heavy

Wave 0 Wave 5 Number of cases = 5868

Figure 3a and b: Unadjusted and adjusted odds ratios predicting poor self rated health:

0.1 1 10

Low risk: weekly Low risk: daily Focal: Hazardous Focal: High Risk Heavy: Hazardous Heavy: High Risk

Odds ratios Log scale

Unadjusted odd ratios Reference: Occasional Drinker

0.1 1 10

Low risk: weekly Low risk: daily Focal: Hazardous Focal: High Risk Heavy: Hazardous Heavy: High Risk

Odds ratios: Log scale

Adjusted odds ratios Reference: Occasional Drinker Adjusted for: Age, gender, wealth, social class, education, household size, smoking, BMI

Longitudinal Analysis

• Multilevel level longitudinal analysis using alcohol

variables in waves 0, 4 and 5

• Quantity:

– Growth curve model of log of weekly units of alcohol consumed – Restricted to drinkers in at least 1 time point (3610 valid cases)

• Frequency

– Ordered logistic regression using frequency of drinking in last 12 months – Restricted to respondents at all 3 time points (4740 valid cases)

Figure 4: Average weekly units over time by gender

1 2 3 4 5 6 7 8 9 1011121314151617181920 4 5 wave sex=male sex=female

Pauline:

In partnership, Retired, Good health, Some qualifications, Non-smoker, Average Wealth

Pearl:

Not in partnership, Retired, Not in good health, No qualifications, Non-smoker, Lowest wealth group

Doreen:

In partnership, Working, Good health, University degree , Former smoker, Highest wealth group

Dorothy:

During 10 year period:

• Loses partner, retires

& health deteriorates A level qualifications Non-smoker, Above average wealth

Age 60 Age 70 Age 80 Age 90 Age 50 Age 60 Age 60 Age 70

3.95 3.50 (11%) 3.43 2.92 (15%) 11.92 10.18 (15%) 5.84 4.54(22%)

Paul:

In partnership, Retired, Good health, Some qualifications, Non- smoker, Average Wealth

Peter:

Not in partnership, Retired Not in good health No qualifications Non-smoker Lowest wealth group

Duncan:

During 10 year period:

• Gets married

Working, Good health, University degree, Former smoker, Highest wealth group

Derek:

During 10 year period:

• Loses partner, retires

& health deteriorates A level qualifications Non-smoker Above average wealth

Age 65 Age 75 Age 80 Age 90 Age 50 Age 60 Age 60 Age 70

6.75 5.76 (15%) 7.47 6.04 (19%) 33.80 28.0 (17%) 7.76 6.81 (12%)

Table 2: Average weekly units consumed for synthetic profiles

• f older people

Figure 5: Percentage distribution of drinking frequency waves 0 and 5

5 10 15 20 25 30 Did not drink in last year Drinks Once or twice a year Drinks

• nce

every couple of months Drinks

• nce or

twice a month Drinks

• ne to

two days a week Drinks three to four days a week Drinks five to six days a week Drinks almost every day Wave 0 Wave 5 Number of cases = 4780

Table 3: Summary of results of longitudinal model of frequency of drinking - 1

Variable Men Women Time (continuous variable)

• 0.11 
• 0.16 

Partnership status Reference: Always in partnership

• Always out of partnership

0.28

• 0.07
• Enters into partnership between waves

0.56 0.47

• Partnerships ends between waves

0.03

• 0.08

Employment status Reference: Always in work

• Always retired

0.28 0.55 

• Transition to retirement between waves
• 0.08

0.13 Health: Reference always in good health

• Always in poor health
• 0.61 
• 1.21 
• Health worsens between waves
• 0.25
• 0.12
• Health improves between waves
• 0.77 
• 0.76 

Men Women Wealth Quintile Reference category: Bottom Quintile

• 2nd Quintile

0.48  0.52 

• 3rd Quintile

0.63  0.80 

• 4th Quintile

0.75  1.42 

• 5th Quintile

1.41  1.97  Education: Reference: No qualifications

• Some qualifications

0.28 0.59 

• A-level or equivalent

0.39  0.80 

• Degree

1.41  1.16 

Table 3: Summary of results of longitudinal model of frequency of drinking - 2

Variable Men Women Partnership status * Time Reference: Always in partnership

• Always out of partnership
• 0.10 
• 0.09 
• Enters into partnership between waves
• 0.01
• 0.07
• Partnerships ends between waves
• 0.02
• 0.07

Health: * Time Reference always in good health

• Always in poor health
• 0.14 
• 0.12 
• Health worsens between waves
• 0.09 
• 0.13
• Health improves between waves
• 0.06
• 0.02

Table 3: Summary of results of longitudinal model of frequency of drinking - 3

Main Findings: Drinking, socio-economic status and partnership

• Older men tend to drink more and to drink more often than

women.

• Men and women in higher income groups and with higher

levels of education drink more and drink more frequently.

• Both the amount that older people drink and how often they

drink declines over time.

• Men who are not in a partnership drink more compared to

men with a partner, though there is no difference in the frequency of men’s drinking by partnership status.

• For women loss of a partner is associated with a faster decline

in weekly alcohol consumption and with drinking less often.

Main Findings: Drinking in later life and health

• Poorer self-rated health is associated with not drinking.
• Among drinkers, there is no evidence that a moderate amount
• f alcohol consumption improves health in later life compared

to heavy drinking.

• Over time older people with poor self-rated health and

deteriorating health report a steeper decline in the quantity and frequency of alcohol consumed (similar finding for depression).

• Those who stopped drinking at the start of the period of
• bservation and remained in the study were more likely to

experience an improvement in health compared to drinkers.

“The public health message should be make sure you’ve got things in place, go and make friends, you know, get you life organised so that you’re enjoying it because I think again anecdotally a lot of men don’t maintain contact with people”

Policy Implications

• Rethink causality between health and drinking in later life?
• Older people moderate their drinking if their health declines.
• But the message that moderate drinking is good for you is not supported by this
• analysis. Furthermore for this sample we did not find that excessive drinking

causes a deterioration of health in later life.

• Those who stopped drinking were more likely to experience an improvement in

health compared to drinkers so cessation may be recommended for older people in poor health.

• Those at most risk of drinking in excess and drinking most frequently are well

educated and have high wealth. This is a concern particularly as the prosperity of

• lder people improves then this may lead to more people drinking excessively in

later life. This group of successful older people could be resistant to public health messages.

• Partnership makes a difference to how much older people drink though this differs

for men and women. The social context of drinking is important and advice about drinking needs to be sensitive to partnership status.