Alcohol abuse, cognitive impairment, and mortality among older people

OBJECTIVES: To estimate the prevalence of alcohol abuse, the association of alcohol abuse with cognitive impairment, and the contribution of alcohol abuse to shortterm mortality in a cohort of older people screened for dementia. DESIGN: Using the Canadian Study of Health and Aging (CSHA)-a representative, national cohort study of 10,268 older persons (greater than or equal to 65 years) from communities and longterm care institutions conducted in 1991-alcohol abuse and dementia were diagnosed during clinical examinations. Death was determined by telephone interview 18 months after baseline and verified by vital statistics records. SETTING: 36 regional community and 17 regional institutional populations in Canada. PARTICIPANTS: The 2,873 individuals from the clinical sample of the CSHA. MEASUREMENTS: Diagnosis of alcohol abuse (questionable, definite, none), diagnosis of dementia. RESULTS: The prevalence of clinically detected definite alcohol abuse was 8.9% (95% confidence interval (CI) 7.9-9.9) and of questionable alcohol abuse was 3.7% (95% CI 3.0-4.4). Definite or questionable alcohol abuse was associated with a younger average age compared with no such abuse history, and men were significantly more likely than women to comprise definite and questionable diagnostic groups as compared with the group without alcohol abuse. The occurrence of all types of dementia except probable Alzheimer's disease was higher in those with definite or questionable alcohol abuse. Mortality at 18 months was higher among these with definite (14.8%, 95% CI 13.5-16.1) or questionable (20.0%, 95% CI 18.5-21.5) alcohol abuse, as, compared with those with no alcohol abuse history (11.5%, 95% CI 10.3-12.7), and alcohol abuse (definite or questionable) conferred a 56% additional risk of short-term mortality (odds ratio (OR) 1.56, 95% CI 1.11-2.20) after adjusting for age, sex, and a diagnosis of dementia. CONCLUSIONS: Alcohol abuse among older people is common and occurs more frequently among men. It is associated with cognitive impairment and independently with short-term mortality. Physician screening for alcohol abuse can yield a group of older people at risk for adverse health outcomes.