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LETTER TO THE EDITOR |
* Department of Internal Medicine and Geriatrics (Poliambulanza Hospital), Brescia, Italy
** University Unit, Geriatric Department, Ullevaal University Hospital, Oslo, Norway
*** Geriatric Research Group, Brescia, Italy
Address correspondence to Renzo Rozzini, MD, Department of Internal Medicine and Geriatrics, Poliambulanza Hospital, via Bissolati 57, Brescia 25124, Italy. E-mail: renzo.rozzini{at}iol.it
To the Editor:
We read with great interest the paper by Strandberg and colleagues regarding a protective effect of moderate alcohol consumption on mortality in a large number of elderly men (1). This observation is in line with other published epidemiological studies in older persons (2,3). We would like to contribute to the discussion with our own data, reporting results obtained in a population of 1201 persons, aged 70–75 years, living in Brescia, Northern Italy, and followed for 12 years.
A questionnaire assessing demographics, social, mental, and functional status, chronic conditions, and healthcare utilization was delivered to the elderly participants and collected at the participants' home by trained community researchers. The response rate of the study was 92.2%.
Alcohol consumption was evaluated by a specific questionnaire asking the amount of intake computed in grams (g). Participants were divided into three groups: abstainers (n = 307), moderate drinkers (n = 697), and heavy drinkers (n = 197). Moderate drinkers were males with an alcohol intake of less than 60 g/d and females with an intake less than 40 g/d; heavy drinkers were males with an alcohol intake greater than 60 g/d and females with an intake greater than 40 g/d. In this study we were unable to discriminate in the abstainer group among life-long abstainers and former drinkers (do former drinkers have worse health status when compared with life-long abstainers?); moreover, differently from Strandberg and colleagues, the amount of alcohol intake was computed independently from different alcoholic beverages.
The survival rate was assessed 12 years from the baseline. Fifty participants were lost at follow-up.
Overall, at baseline, the clinical and psychosocial characteristics of moderate drinkers were better in comparison to abstainers since they had better mood patterns (adjusted Beck Depression Inventory Scale) and a higher mean cognitive function (MSQ). Moreover they were less disabled (IADL and BADL), had a lower number of chronic diseases, a higher level of education, and a larger number lived alone.
Heavy drinkers were more frequently male and married or living with others; they were less disabled and depressed, and used less healthcare (and medications)s, but they were poorer (see Table 1).
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After controlling for potential confounders (i.e., those variables associated to 12-year mortality: being male, low income, disability, dementia, depression, and somatic comorbidity), moderate drinking was shown to have a positive effect on mortality. In comparison with abstainers, taken as reference group, and heavy drinkers, the adjusted relative risks (RR) were 0.7 (95% confidence interval [CI] 0.6–0.9) and 0.9 (95% CI 0.7–1.2) respectively. This association holds even after exclusion of events that occurred soon after the baseline evaluation (i.e., 18 months): The adjusted RR were 0.7 (95% CI 0.6–0.9) and 0.9 (95% CI 0.7–1.1), respectively.
Data suggests that the population of moderate drinkers is characterized by better health. The higher rate of participants living alone in this group further confirms the hypothesis of overall better health condition (4,5), since only healthy persons may live without support. We hypothesize that moderate drinking characterizes a subpopulation of persons with higher physical and mental performance, more open to social contacts, and able to exert "mastery" on their own lives, and, as a consequence, with a longer life expectancy. The population of heavy drinkers has a short life expectancy probably due to well-known risk factors in old age (i.e., being prevalently male and poor), although they are partially controlled by the low depression rate and high family ties. Furthermore their good overall health and functional condition may be explained by the fact that they are survivors, while the larger part of heavy alcohol drinkers has been subjected to the "harvesting" phenomenon.
In conclusion, we agree with Strandberg and colleagues (1) that further studies are needed to finally establish whether the survival differences induced by alcohol may be ascribed to the peculiar health characteristics of participants or to a potential "pharmacological" action of different amounts of alcoholic beverages.
References
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