1. 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

2. 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:

3. 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

4. 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

5. 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)

6. 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

7. 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)

8. 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

9. 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

10. 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%

11. 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)

12. Methodology
Flanders:

13. 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

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

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

16. 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%

17. 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

18. 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

19. 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

20. 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

21. 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

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

23. 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

24. 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!