Older adults in wealthier countries drink more alcohol

A new global study finds older people in wealthy countries consume more alcohol than their counterparts in middle-income countries, on average, although a higher cost of alcohol is associated with less frequent drinking. Across counties, people drink less as they get older, but at different rates and starting points. The study was led by researchers at Columbia University Mailman School of Public Health and the Robert N. Butler Columbia Aging Center. Findings are published in the journal Addiction.

Alcohol consumption among older adults is trending higher across numerous countries, and alcohol use disorders among adults 65 and older have more than doubled in the last ten years. Moreover, there are signs that alcohol consumption is further increasing during the pandemic. Age-related changes that slow metabolism and increase the odds of medication interactions make alcohol consumption likely more harmful among older than younger adults.

The researchers analyzed survey data collected from 100,000 individuals age 50 and older in 17 countries in Europe, as well as China, Mexico, Israel, South Korea, and the United States. Average weekly alcohol consumption ranged from 0.59 units in Mexico to 6.85 units in the Netherlands. In the United States, older adults consumed 2.07 standard units per week. One standard unit is equivalent to a small shot glass of vodka or a 12oz glass of 5 percent beer.

The price of alcohol—measured by the cost of a bottle of red label Smirnoff vodka—varied from a low of $7.92 in Mexico to $38.06 in Ireland (4.96 standard units/week).

In most countries drinking decreased with age (U.S., China, Chile), but some countries had sharper age-related decreases (England, Ireland, Czech Republic) and others were fairly stable and had brief increases in drinking after age 50 (Denmark, France). This variation across age and countries is explained both by the health and socioeconomic status of older adults living in each country and country-level factors like economic development and alcohol prices.

Heavy drinking among older adults was highest in the Czech Republic and lowest in Israel, with levels of heavy drinking in most countries declining by age or slightly increasing then declining by older ages. Economic development and the cost of alcohol did not influence levels of heavy drinking, which may be driven by factors such as gender and cultural norms. Heavy drinking is defined for men as having more than three drinks per day or binging more than five drinks in a single occasion, and for women as having more than two drinks per day or binging more than four drinks in a single occasion.

"Public concern over drinking largely focuses on young people, but alcohol is also a serious threat to the health of older adults. In fact, the majority of alcohol-related deaths occur among older people," says first author Esteban Calvo, Ph.D., assistant professor of epidemiology in the Robert N. Butler Columbia Aging Center. "While some studies purport to show a benefit to drinking in old age, these findings are likely distorted by the fact that older drinkers tend to remain drinking if they are healthy, while recent abstainers (as opposed to lifetime abstainers) may only quit when they are sick."

"As countries develop economically and older people living there can afford to drink more, these countries should consider policies to regulate alcohol consumption, potentially combining minimum alcohol prices, taxation, sale and marketing regulations, and cessation programs," adds senior author Katherine M. Keyes, Ph.D., associate professor of epidemiology at Columbia Mailman School.