Alcohol use (and abuse) has historically been less frequent among middle-aged and older adults relative to young adults, yet the frequency of alcohol use among middle-aged and older individuals is increasing (1
). In the 2001 to 2002 National Epidemiologic Survey on Alcohol and Related Conditions, 37% of women and 55% of men who were ≥65 years of age reported that they currently used alcohol (3
). Just over 1% of elderly women and 4.8% of elderly men were thought to have a 12-month DSM-IV diagnosis of alcohol abuse or dependence (2
). However, results from the Canadian Study of Health and Aging yielded estimates of alcohol abuse of 8.9% among persons who were ≥65 years of age in a clinical sample (4
). Reasons for the increasing prevalence in this age group may be that alcohol use in moderate quantities has not been found to lead to a significant increase in adverse health outcomes and might (arguably) improve health and that the rising cohorts in this age group have consumed more alcohol than past cohorts during the 20th century. For example, Balsa and colleagues (3
) found that light to moderate alcohol consumption by older women (≥65 years of age) was associated with better self-perceived health status, improved cardiovascular health, and lower rates of hospitalization. No significant negative or positive associations were found for older men.
In the 2001 to 2002 National Epidemiologic Survey on Alcohol and Related Conditions, binge drinking was identified in 14% of men and in 6% of women (i.e., one binge drinking episode in the past year) (5
). Binge drinking could be a significant potential health hazard that is not as frequently recognized in middle-aged and elderly adults. In another community survey (6
), binge drinking was found to be more common among adults aged ≥26 years than previously estimated and carried some significant risks. Seventy-three percent of all respondents who reported binge drinking drank moderately not heavily (although those who drank heavily were more likely than those who drank moderately to binge drink). Additionally, individuals who reported binge drinking were 14 times more likely to drive while impaired by alcohol compared with individuals who did not binge drink. Among adults ≥55 years old who reported consumption of alcohol, 15% of men and 4.7% of women reported an episode of binge drinking during the past 30 days. Frequency overall increased between 1993 and 2001. Caucasians and Hispanics were more likely than African Americans and men were more likely than women to binge drink. Further, college graduates had a slightly lower prevalence of binge drinking than those who did not attend college.
Binge drinking may vary across cultures, yet it is a potential problem in many cultures. In Denmark, binge drinking is typical among youth and decreases with increasing age. For example, in a national survey in Denmark, 38% of men and 18% of women drank heavily in episodes. In a general health survey of 513 Swedish women aged 50 to 59 years old (6
), 56.6% of respondents who reported alcohol consumption affirmed binge drinking within the past year and 39.4% affirmed binge drinking during the past month. A survey in Brazil among subjects ≥60 years of age (7
) estimated that 12% of respondents were individuals who drank heavily, 10.4% reported binge drinking, and 2.9% were alcohol dependent. Predictors of binge drinking and heavy drinking were male sex and younger age but not educational level or depression, and binge drinking was more frequent in the higher income group. These results suggest that at-risk and binge drinking may be hidden from many clinicians because the usual correlates of alcohol use disorders may not apply to binge drinking. In addition, binge drinking may be much more common in middle-aged and elderly women than what is usually assumed.
Data from the Medicare Current Beneficiary Survey in 2003 (N=12,413) revealed that 9% of elderly beneficiaries reported unhealthy drinking (men, 16%; women, 4%) (8
). Higher education and income; better health status; male sex; younger age; smoking; being Caucasian; and being divorced, separated, or single were associated with an increased likelihood of unhealthy drinking. Hispanic ethnicity was associated with heavy episodic drinking (four or more drinks in a single day during a typical month in the previous year). Heavy episodic drinking was found in 1.2% of women and 3.5% of men. Drinking to relieve tension was affirmed by 7.2% of women (perhaps a risk for binge drinking). These women reported more mental symptoms and less contact with friends relative to the remainder of the sample.
Adverse health effects of binge drinking are unintentional injuries, intentional injuries (e.g., domestic violence), sexually transmitted diseases, high blood pressure, stroke, other cardiovascular diseases, liver disease, neurological damage, and poor control of diabetes. Despite these health hazards, most people who binge drink are not alcohol dependent and therefore may not be recognized clinically as engaged in at-risk drinking (9
). These health hazards clearly present more negative consequence in later life when natural body defenses decrease and multiple illnesses from other causes may be aggravated by binge drinking. For example, binge drinking has been associated with impairments in instrumental activities of daily living (10
). In addition, binge drinking has been associated with gambling among older adults (11
In the present study, we demonstrate the prevalence and distribution of alcohol use, including at-risk drinking and binge drinking, in a national representative sample of U.S. men and women aged ≥50 years old (approximately 40% of whom were ≥65 years of age) from the National Survey on Drug Use and Health. To increase the sample size, we combined 2 years (2005 and 2006) of data. Given that alcohol use and problematic alcohol use among middle-aged and older adults are predicted to increase over time as a result of the aging baby boomer population (12
), we examined self-reported use of alcohol, with a focus on binge drinking. Binge drinking is defined by the National Survey on Drug Use and Health as the consumption of five or more drinks on the same occasion (i.e., at the same time or within a couple of hours apart) on at least 1 day in the past 30 days (13
). We demonstrate the prevalence and correlates of alcohol use and binge drinking among all respondents, with specific attention to women. Among the subset of respondents who reported alcohol use in the past year, we examined the factors associated with at-risk drinking and binge drinking.