"Following on the 1997 success of the Trial for Early Alcohol Treatment (Project TrEAT), conducted by the same research team in problem drinkers aged 18-64, these results are good news for the fastest growing segment of the U.S. population," said Enoch Gordis, M.D., Director, National Institute on Alcohol Abuse and Alcoholism. "Even for patients who do not meet diagnostic criteria for alcohol dependence (alcoholism) or alcohol abuse, the combined effects of alcohol and aging increase the risk of falls, fractures, traffic crashes, medication interactions, depression and other medical conditions."
Results from surveys of different age groups in the community suggest that the elderly, usually defined as persons older than 65 years, consume less alcohol and have fewer alcohol-related problems than younger drinkers. In contrast, surveys conducted in health care settings have found increasing prevalence of alcoholism among older adults. In acute care hospitals, rates of alcohol-related admissions are similar to rates for heart attacks, and some surveys have found nursing home prevalence of problem drinking to be as high as 49 percent.
A 1996 study conducted in community clinics reported that 15 percent of men and 12 percent of women aged 60 years and older regularly drank in excess of one drink each day, the limit recommended by NIAAA for any older person who drinks. NIAAA's recommendation is based on animal and human studies that suggest that sensitivity to alcohol's health effects increases with age (see Alcohol Alert Number 40, April 1998).
For Project GOAL, Michael Fleming, M.D., M.P.H., and colleagues at the University of Wisconsin Medical School administered a health screening survey to men and women aged 65 years and older with regularly scheduled appointments in 24 Wisconsin health care clinics. The clinics were located in rural and urban areas in south central and southeastern Wisconsin and varied from solo sites to large managed care organizations.
Of 6,073 patients screened, 656 screened positive as men who consumed more than 11 drinks or women who consumed more than 8 drinks a week; men who had consumed 4 or more drinks or women who had consumed 3 or more drinks on at least two occasions during the past 3 months; or persons who reported two or more positive responses to the CAGE, a standard screening instrument for problem drinking.
Of 496 patients willing to participate, 396 completed face-to-face interviews in a physician's office. The interviews gathered additional information on alcohol use, medications, injuries, depressive symptoms, and other medical and social characteristics. The 158 patients who remained eligible after exclusion for alcohol withdrawal symptoms, past alcohol treatment, cognitive impairment, or suicidal ideation were randomized to either an intervention or control group.
Patients in the intervention group received a general health booklet and were scheduled to see their personal physicians for two 10- to 15-minute interventions one month apart. The brief intervention protocol included a workbook with feedback on the patient's health behaviors, a review of problem-drinking prevalence, adverse effects of alcohol, the patient's reasons for drinking and drinking cues, a drinking agreement in the form of a prescription, and drinking diary cards. In addition, the intervention group received a reinforcement telephone call from the clinic nurse 2 weeks after each physician visit.
Patients in the control group received the general health booklet only. Both groups received follow-up interviews at 3, 6, and 12 months regarding general health behaviors including alcohol use. Family members were contacted at 12 months to corroborate patient reports of health behaviors.
Patients in the intervention group experienced a 34-percent reduction in 7-day alcohol use, a 74-percent reduction in mean number of binge-drinking episodes, and a 62-percent reduction in the proportion of older adults who consumed more than 21 drinks a week. These data provide the first direct evidence that brief physician advice can decrease alcohol use by older adults in community-based primary care practices. According to principal investigator Michael Fleming, M.D., "Efforts should be undertaken to incorporate brief intervention protocols into routine clinical practice."
To interview Dr. Fleming, telephone (608) 263-9953. To interview Dr. Gordis, contact NIAAA Press at (301) 443-3860. Additional alcohol research information is available at http://www.niaaa.nih.gov.