Aims: This research involved three studies. The aim of Study 1 was to conduct a national key informant survey to investigate appropriate alcohol guidelines for 65 to 74 year old Australian men and women. The aim of Study 2 was to assess the accuracy of self-reported alcohol consumption amongst a sample of 65 to 74 year old men and women based upon an examination of their alcohol pouring practices. The aim of Study 3 was to assess the prevalence of at-risk alcohol consumption amongst an Australian national sample of 65 to 74 year old current drinkers based upon the recommended alcohol guidelines from Study 1 and the results from investigation of the pouring practices of participants from Study 2.
Methods: Study 1 involved telephone interviews with 32 key informants from across Australia to investigate potential alcohol guidelines for older Australians. Study 2 involved face-to-face interviews with 844 men and women aged 65 to 74 years of age from Perth, Western Australia. All participants had consumed at least one full serve of alcohol in the prior twelve months. Participants were required to pour their "usual" amount of alcohol and were then interviewed about their alcohol consumption and the relationship between the amount of alcohol they poured and a standard drink. Participants were also invited to recommend alcohol guidelines for other older men and women. Study 3 involved secondary analysis of the 2004 National Drug Strategy Household Survey (NDSHS) data set.Data from 2,300 Australian men and women aged 65 to 74 years were analyzed to determine the prevalence of at-risk consumption of alcohol based upon the results from Studies 1 and 2.
Results: Key informants recommended that older men should consume no more than 2 (mean=2.35) standard drinks per day to avoid the risk of long-term alcohol-related harm and no more than 3 (mean=3.55) standard drinks per day to avoid the risk of short-term alcohol-related harm. They also recommended that older women should consume no more than 1 (mean=1.45) standard drink per day to avoid the risk of long-term alcohol related harm and no more than 2 (mean=2.45) standard drinks per day to avoid the risk of short-term alcohol-related harm. These levels were significantly less than the National Health and Medical Research Councils (2001) Australian Alcohol Guidelines, which have been used in national studies to assess the prevalence of alcohol-related risk amongst 65 to 74 year old Australians. Results from Study 2 indicated that based upon amounts of alcohol poured by older men and women, men under-estimated alcohol consumption by 32% and women by 16%. However, following investigation of how individuals converted the amounts of alcohol that they poured into standard drinks, older Australian men underestimated their alcohol consumption by 23% and older women by 16%. Data from the 2004 National Drug Strategy Household Survey (NDSHS), indicated that 2.9% of older Australian men were at-risk of short-term alcohol-related harm (based upon the NHMRC, 2001) alcohol drinking guidelines. However, when results from Studies 1 and 2 were used to reanalyze the data, the percentage of older Australian men at-risk of short term alcohol-related harm increased to 12.6% (based upon key informant guidelines combined with the degree of under-reporting of consumption from Study 2). Similarly, the figures for older Australian women rose from 1.3% at-risk of short-term alcohol-related harm to 5.1 %. For long-term harm, the percentage of older Australian men at-risk of harm rose from 10.2% to 35.2% and for older Australian women the figures increased from 8.0% to 30.9%.
Conclusions: Existing alcohol guidelines are not appropriate for older Australians. When used as a benchmark to ascertain the prevalence of at risk drinking, they are likely to underestimate the extent of risk. As older people under-report their consumption of alcohol, doubt exists about the accuracy of present prevalence estimates of at-risk consumption amongst older people. Future research investigating prevalence of at-risk alcohol consumption should be based upon age appropriate alcohol guidelines and be adjusted to account for an under estimation in self-report. While younger age groups also over-pour standard drinks, without assessing whether or not they convert these amounts to standard drinks in self-report surveys, it is not possible to ascertain whether the degree of underreporting of consumption is larger or smaller with different age groups. Answering these questions is important from an epidemiological and public health perspective to provide accurate estimates of the prevalence of at-risk consumption across the population.