Prof. Dr. Eva Dierckx & Prof. Dr. Bart Van Rompaey Identifying & clarifying alcohol patterns of older people in Flanders. The association between depression and alcohol use among older adults. Dra. Yannic van Gils Prof. Dr. Eva Dierckx & Prof. Dr. Bart Van Rompaey Prof. Dr. I. Ponjaert-Kristoffersen & Prof. Dr. M. Elseviers

Older adults (60+) are the fastest growing segment of the population Introduction Older adults (60+) are the fastest growing segment of the population Worldwide almost 2 billion people will be aged 60+ in 2050 (WHO) Due to 1. the babyboom generation are 60+ starting in 2010 and 2. the life expectency are longer now and will stil rise during the following years In Western Europe:

Introduction Population division in Europe in 2050*: * United Nations Department of Economics and Social Affairs Population division in Europe in 2050*: For the first time in history the segment of older adults will be larger than the children’s segment

Average health care costs per year in € Introduction Health care use in Western Europe: Prevention € Average health care costs per year in € AS THIS SEGMENT OF THE POPULATION IS RISING, THE BURDEN ON OUR HEALTH CARE SYSTEM WILL RISE TOO Increase of use of health care system by age Therefore prevention will be the key for our systems to be able to help the needed age

Introduction Alcohol use: A high prevalence of alcohol use among older adults is reported in different parts of the world Prevalence Europe 47.9% to 73% US 51.1% to 83.3% Australia 48,1% on average Asia men: 31.3% to 44.1% women: 4.8% to 9.3% Asia data need to be gender specific due to the hugh difference in alcohol use between men and women (Breitling et al. 2010; Gargiulo et al. 2013; Hoeck and Van Hal 2013) (Blazer and Wu 2011; Lopes et al. 2010; McEvoy et al. 2013) (McCaul et al. 2010) (Kim et al. 2009; Sun et al. 2009)

Physiological changes associated with aging Introduction Older adults are particularly vulnerable for alcohol related problems (NIAAA, 2005) Physiological changes associated with aging Greater potential for medication-alcohol interactions Increased prevalence of comorbid conditions Physiological changes: decline body water content tend to have higher blood concentration after a standard drink aging interferes with the ability to adapt to the presence of alcohol Coussins : 72% of the elderly taking medication are expost to medication that can interact with alcohol. Of those 60% reported drinking alcohol Comorbid conditions like: cognitive decline, cardivascular deseases

This has been supported by several studies in Europe Introduction Depression: The WHO (2001) estimated the prevalence rate to be 10 to 20% among the elderly (depending on the cultural situations) This has been supported by several studies in Europe + ZIVIN US 14,6% en UK 17,6% YAKA 17,1% (turquey)

Introduction Older adults with risky health factors like depression and alcohol use Larger pattern of health risk behaviours Report medical morbidity and mortality Have an increased risk for health deterioration Have an increased risk for cognitive and social decline Manifest self-neglect and suicide Emotional problems and anxiety

Introduction The literature is inconclusive about the association between depression and alcohol use among the elderly Some authors reported evidence that depressive symptoms are linked to alcohol use and alcohol misuse (Kirchner et al, 2007; St.John et al, 2009) Some authors did not found the same association (Coussins et al, 2014; Ruf et al, 2014) Coussins: hevay drinkers do not report more frequently depression than moderate drinkers or non drinkers. Also moderate drinkers not more depressions than non drinkers Ruf even in men and women there is no difference between the drinking patterns and depression

To determine the prevalence of alcohol use among older Flemish adults Introduction Aims of the study: To determine the prevalence of alcohol use among older Flemish adults To determine the prevalence of depression among older Flemish adults To determine if depressive symptoms are associated with alcohol use among older adults + ZIVIN US 14,6% en UK 17,6%

Able to complete the questionnaire in our language (Flemish) Methodology Participants: 1005 participants 60 years and older No dementia Able to complete the questionnaire in our language (Flemish) Face to face interview with a sealed envelope Privacy of their homes High response rate Decrease in social desirable answers on alcohol use because of the sealed envelope (WHO, 2000) Decrease social desirable answers (sociaal wenselijk)

Methodology Flanders:

Very high risk drinking Methodology Drinking patterns (WHO, 2000): Men Women Low risk drinking 1-4 drinks/day 1-2 drinks/day Medium risk drinking 5-6 drinks/day 3-4 drinks/day High risk drinking 7-10 drinks/day Very high risk drinking >10 drinks/day >6 drinks/day Women are more sensitive to effects of alcohol and therefore a gender specific category system

Methodology Depression: GDS: Geriatric Depression Scale (15) Score ≥ 6  likelihood for depression

Results: demographics Participants: N: 1005 402 men (40,1%) 600 women (59,9%) 2 missing values Age 75 years sd 8,82 Range 59 - 110

Results: prevalence of alcohol use among older Flemish adults Drinking patterns 70,6% 75,5% of older adults are drinking alcohol 24,5% 3,6% 1,3%

Results: prevalence of alcohol use among older Flemish adults Alcohol patterns women men Sign. Non drinkers 32,2% 12,7% .000 Low risk 64,8% 79,6% Medium risk 2,7% 5,0% (Very) high risk 0,3% Men are more represented in the drinking categories and less in the non drinkers category

Results: prevalence of depression among older Flemish adults 70,3% 29,7% Almost 30% of older adults scored ≥6 on the GDS GDS<6 GDS≥6

Results: prevalence of depression among older Flemish adults Likelihood for depression women men Sign. GDS<6 72,0% 68,6% .602 GDS≥6 28,0% 31,4% There is no difference between men and women reporting depression

Results: alcohol use and depression among older Flemish adults No significance. Likelihood for depression Non drinkers Low risk Medium risk Sign. GDS<6 76,4% 68,9% 44,4% .171 GDS≥6 23,6% 31,1% 55,6% Uitleg: in the non drinkers and low risk categories, they were more elderly reporting no depression. In the category medium risk more elderly reported depression We have left the high/very high category because there were not enough respondent in it Likelihood for depression Medium risk drinkers reported depression more frequently

Results: association between alcohol use and depressive symptoms Significant difference in depressive symptoms between medium risk drinkers and non drinkers and low risk drinkers Laatste categorie is niet representatief

Discussion High prevalence of alcohol use in Flanders Higher than previous research 75,5% (Europe: 47,9-73%) Why? Cultural factor Sealed envelop method

Discussion High prevalence of likelihood for depression among older adults in Flanders Much higher than reported by WHO 29,6% (WHO: 10-20%) Why? Social isolation due to living situation Methodological issues

Conclusion Medium risk drinkers reported significant more depressive symptoms These results showed an association between depressive symptoms and alcohol use Medium risk drinkers need monitoring and education on safe drinking to prevent further decline of their mental health More research is necessary ! Policy for recommended alcohol intake is necessary!