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. 2020 Jul 14;37(4):400–410. doi: 10.1177/1455072520936813

Elevated alcohol consumption among geriatric psychiatric in-patients

Anne-Sofie Helvik 1,✉, Knut Engedal 2, Aud Johannessen 3
PMCID: PMC8899249  PMID: 35310925

Abstract

Introduction:

Although a clear relationship has been established between elevated alcohol consumption and psychiatric problems in old age, there are few descriptions of the prevalence of elevated alcohol consumption in older adults who have been referred to geriatric psychiatric treatment.

Aim:

To describe the prevalence of self-reported elevated alcohol consumption in men and women referred to geriatric psychiatry wards in Norway, and to explore factors associated with elevated alcohol consumption.

Method:

This cross-sectional study includes data from a registry of geriatric psychiatry patients aged ≥ 65 years from December 2016 until December 2018. The outcome measure was reported elevated alcohol consumption assessed with the short version of the Alcohol Use Disorders Identification Test (AUDIT-C). The analyses used demographic data as well as a measure of cognitive function, psychiatric diagnosis and use of psychotropic drugs.

Results:

In total, 367 patients (131, 35.7% men) with a mean (SD) age of 74.7 (7.6) years were included. Of these patients, 27% scored above the pre-set cut-off for elevated alcohol consumption according to AUDIT-C (≥ 3 and 4 for women and men, respectively). The prevalence of elevated alcohol did not differ by gender. In adjusted logistic regression analysis, older age, living with someone and use of antidepressants were associated with reduced odds for reporting elevated alcohol consumption (OR 0.93, 95% CI 0.89–0.96; OR 0.54, 95% CI 0.31–0.97; and 0.54, 95% CI 0.32–0.92, respectively).

Conclusion:

A relatively high proportion of psychiatric patients aged 65 years or older reported elevated alcohol consumption, regardless of diagnosis. Older age, living with someone and use of antidepressants were associated with lower odds for elevated alcohol consumption.

Keywords: addiction, elderly, misuse, old-age psychiatry, older people, registry, risky use, senior citizens, substance abuse

Adults older than 65 years are generally more vulnerable to the effects of alcohol compared to younger adults, with regard to occasional, regular, and elevated alcohol consumption (Hallgren, Högberg, & Andreasson, 2009). In the decade to come, a larger proportion of older people will have a higher education compared to old people today. Such a change may be expected to contribute to higher alcohol consumption (Slagsvold & Hansen, 2017). Elevated consumption entails harmful and risky use as well as misuse. However, neither the guidelines for various countries nor the Diagnostic and statistical manual of mental disorders (DSM-5) contain a standard definition of elevated consumption (Hoffmann & Kopak, 2015). It is generally recommended that people aged 65 years and older limit their alcohol consumption to one unit per day. Even so, alcohol consumption below this limit may also harm some frail older people (Fillmore, Stockwell, Chikritzhs, Bostrom, & Kerr, 2007; Moos, Brennan, Schutte, & Moos, 2004), in being linked to health problems due to age-related physiological changes (Davies & Bowen, 1999; Institute of Alcohol Studies, 2013; National Institute on Alcohol Abuse and Alcoholism, 1998; Squeglia, Boissoneault, Van Skike, Nixon, & Matthews, 2014) as well as many of the commonly prescribed drugs given to older people (Korrapati & Vestal, 1995).

Alcohol is stated to have a negative influence on at least 60 medical diseases (World Health Organization, 2004) and negatively affects cognitive function if alcohol consumption has been elevated over time (Kuzma, Llewellyn, Langa, Wallace, & Lang, 2014; Langballe et al., 2015). Moreover, a review reported an association between medical health problems and degree of alcohol consumption among older individuals (Sorocco & Ferrell, 2006). Furthermore, there are reports of relationships between elevated alcohol consumption and suicide and psychiatric illness, such as depression and anxiety, but it is not always easy to tell which came first, the disease or the elevated alcohol consumption (Caputo et al., 2012). Also, it is highlighted that older peoples’ psychosocial status, such as being retired, bored, lonely or homeless, is linked to elevated alcohol use (Holdsworth et al., 2017). In this context, there is also a gender perspective, but women today have moved more towards men’s patterns of drinking (Bratberg et al., 2016). Lastly, regular, frequent and elevated alcohol consumption are in general found to be associated with a higher level of education (Johannessen, Engedal, Larsen, Stelander, & Helvik, 2017; Li, Wu, Selbaek, Krokstad, & Helvik, 2017; Li, Wu, Tevik, Krokstad, & Helvik, 2019; Tevik et al., 2019).

Among older people, the relationship between elevated alcohol consumption, the risk factors for this type of consumption and mental health is hardly known (Støver, Bratberg, Nordfjørn, & Krokstad, 2012). Even though research on this topic has been conducted amongst younger age groups, the results may not easily be extrapolated to older age groups. A previous small study explored the association between patients’ and general practitioners’ (GPs) information and elevated alcohol consumption among patients referred to geriatric psychiatry wards (Johannessen, Engedal, Larsen, et al., 2017). However, factors associated with patient-reported elevated consumption were not explored. Thus, we wanted to further explore this topic.

Aim

The aim was to describe the prevalence of self-reported elevated alcohol consumption in women and men referred to treatment by specialist mental healthcare services designed for older people, and to explore factors associated with elevated alcohol consumption.

Method

Setting and participants

This cross-sectional study acquired data from the Norwegian Quality Registry of Geriatric Psychiatry Patients from both the southern and northern parts of the country from December 2016 until December 2018. The inclusion criteria for the present study were: age ≥ 65 years, answered the short version of the Alcohol Use Disorders Identification Test (AUDIT-C) (Babor, De La Fuente, Saunders, & Grant, 1989) and capacity to give informed written consent to participate in the study. No specific exclusion criteria were defined.

Of 708 patients (≥ 65 years) included in the registry between December 2016 to December 2018, 367 (51.8%) had answered the AUDIT-C and were included in the study.

Assessment of the patients

The outcome variable was the Alcohol Use Disorders Identification Test (AUDIT-C) (Babor et al., 1989). This test has three items assessing alcohol consumption, where each item is rated from 0 to 4, giving a sum-score. Higher scores indicate higher consumption. The cut-off score for elevated alcohol consumption on AUDIT-C was set to 3 for women and 4 for men (Crome, Dar, Janikiewicz, Rao, & Tarbuck, 2011). Socio-demographic characteristics included the variables age, gender, living alone (or not), and level of education (≥ 10 years or < 10 years). Information was provided by patients. Cognitive function was assessed by the Mini Mental State Examination (MMSE), Norwegian revised version (Engedal, Haugen, Gilje, & Laake, 1988; Folstein, Folstein, & McHugh, 1975; Strobel & Engedal, 2008). The scale consists of 20 items, with a possible score between 0 and 30. A lower score denotes more impairment. The World Health Organization’s International statistical classification of diseases and related health problems, 10th edition for research (ICD-10) (World Health Organization, 2010) was used to make diagnoses, which were made by specialists in geriatric psychiatry at discharge from the hospital. Further, the psychotropic drugs prescribed at discharge were grouped according to the Anatomical Therapeutic Chemical (ATC) (WCC+DSM, 2019) code into the following categories: antipsychotics (N05A except lithium), antidepressants (N06A), anxiolytics (N03A & N05B), hypnotics/sedatives (N05C), and opioids (N02A) (yes versus no). This information was collected from hospital medical records.

Procedure

A consent-based quality registry that includes patients admitted to in-patient wards in geriatric psychiatry in Norway has been approved by the Norwegian Directorate of Health and the Data Protection Agency (Kristiansen & Engedal, 2013). Data in the registry are from a comprehensive and standardised examination protocol used in 13 hospitals. AUDIT-C was included in the registry in December 2016. The assessments were conducted during the first two weeks after admission, whereas the primary diagnoses and drugs taken (or prescribed) in this study were made at discharge. The study was presented to the Regional Committee for Ethics in Medical Research, Southern Norway, and was approved (number 2017/2439). Ethical principles outlined in the Helsinki Declaration (World Medical Association, 2013) were followed.

Statistics

The statistical analysis was performed with IBM SPSS version 25 (Chicago, IL, USA). Descriptive analysis for categorical variables was performed with the Pearson’s chi-squared test or Fisher’s exact test (depending on sample size) and for continuous variables, the non-parametric Mann–Whitney U test was used since the data were not normally distributed.

Logistic regression analysis (the ‘Enter’ method) was performed to study factors associated with the outcome elevated reported use of alcohol (AUDIT-C ≥ 3/4 for women and men, respectively) versus no elevated reported use. Independent variables included in the unadjusted analysis were demographic variables (gender, age, living alone, and level of education), diagnoses, and information about psychotropic drugs used at study entrance. All demographic variables and variables regarding diagnoses and psychotropic drugs associated with the outcome variable at p ≤ 0.150 level in the unadjusted analysis could be potential confounders and were included in the adjusted logistical regression model. Due to missing information on independent variables, the total number in the adjusted regression analysis was 306 patients.

Tests were performed for interaction between gender and other independent variables as well as possible collinearity between independent variables. Probability values below 0.05 were considered statistically significant.

Results

Sample characteristics

Of a total of 367 patients, 131 (35.7%) were men and the mean (SD) age for the total sample was 74.7 (7.6) years (Table 1). Men were significantly younger and less likely to live alone compared to women. No gender differences were found between mean MMSE and frequency of various categories of diagnoses. The category “other diagnoses” included 10 patients with diagnoses due to alcohol misuse (three men) and eight patients with disorders due to psychotropic or illegal drug use (one man).

Table 1.

Characteristics of the sample by gender (n = 367).

  All Men Women p < 0.05a
Number N (%) 367 100% 131 (35.7) 236 (64.3)
Socio-demographic information
Age Mean (SD) 74.70 (7.6) 72.89 (7.2) 75.71 (7.6) 0.001
Education ≥ 10 yearsb N (%) 201 (54.8) 76 (58.8) 125 (53.0) 0.123
Living aloneb N (%) 197 (53.7) 46 (35.1) 151 (64.0) < 0.001
Functional
MMSE scoreb,c Mean (SD) 25.10 (4.4) 25.10 (5.2) 25.10 (3.9) 0.997
Main diagnoses 354 (96.5) 0.841
MCI and dementiad N (%) 79 (21.5) 28 (21.4) 51 (21.6)
Psychosis N (%) 30 (8.2) 9 (6.9) 21 (8.9)
Affective disorders N (%) 164 (44.7) 63 (48.1) 101 (42.8)
Anxiety N (%) 43 (11.7) 14 (10.7) 29 (12.3)
Others including disorder due to abusee N (%) 38 (10.4) 12 (9.2) 26 (11.0)
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Note. Bold numbers are for significant findings. MCI = Mild cognitive impairment.

a The non-parametric Mann–Whitney U test was used for continuous data and Chi-square test was used for categorical data. bMissing information. cCognitive function was assessed using the Mini Mental State Examination (MMSE). dMCI diagnosed with mild cognitive impairment (17 of 79 patients in this category). eOf others, ten were diagnosed with disorders due to alcohol and eight with disorders due to psychotropic drugs and illegal drugs.

The 341 patients who did not answer the AUDIT-C did not differ in terms of age (mean age 75.8, SD 7.8 years), gender (31.3% men), educational level (44.9% with ≥ 10 years), living alone (54.3%), cognitive functioning (mean MMSE 24.7, SD 4.7) or category of diagnoses (mild cognitive impairment and dementia 24.6%, psychosis 8.8%, affective disorder 49.6%, anxiety 10.0% and other diagnoses 10.9%) from those who responded to the AUDIT-C.

Elevated alcohol consumption and use of psychotropic drugs

In total, 98 of 367 (26.7%) scored above a predefined cut-off from AUDIT-C, which indicates elevated alcohol consumption, and no gender difference was found. However, men living alone more frequently reported elevated alcohol consumption than men not living alone (p = 0.005), but no such differences were found among women. Women with high education levels (≥ 10 years) more frequently reported elevated alcohol consumption than women with low education levels (< 10 years) (p = 0.016), but no such significant differences were found among men.

Men less often used anxiolytics and sedatives than women, but no gender differences were found for the use of other psychotropic drug categories (Table 2). Women using antidepressants were less likely to report elevated alcohol consumption than those not using antidepressants (p = 0.006), but no such difference was found for men.

Table 2.

Elevated alcohol consumption and psychotropic drugs taken (or prescribed) by gender (n = 367).

  All Men Women p < 0.05a
Number N (%) 367 100% 131 (35.7) 236 (64.3)
Alcohol
Elevated alcohol consumptionb N (%) 98 (26.7) 37 (28.2) 61 (25.8) 0.619
Psychotropic drugs
Antipsychotics (N05A) N (%) 151 (41.1) 55 (42.0) 96 (40.9) 0.807
Anxiolytics (N03A & N05B) N (%) 72 (19.6) 16 (12.2) 55 (23.3) 0.008
Hypnotics and sedatives (N05C) N (%) 120 (32.7) 31 (23.7) 89 (37.7) 0.006
Antidepressants (N06A) N (%) 202 (55.0) 66 (50.4) 136 (57.6) 0.181
Opioids (N02A) N (%) 21 (5.7) 7 (5.3) 14 (5.9) 0.816
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Note. Bold numbers are for significant findings.

a The non-parametric Mann-Whitney U test was used for continuous data and Chi-square test was used for categorical data.

bElevated alcohol consumption: The short version of the Alcohol Use Disorders Identification Test (AUDIT-C) cut-off ≥ 3/4 for women/men.

In adjusted logistic regression analysis, higher age, living with someone and use of antidepressants were associated with reduced odds for reporting elevated alcohol consumption (Table 3). The explained variance was 15.9% (using Nagelkerke’s R-squared).

Table 3.

Participant reports of elevated use of alcohol assessed with AUDIT-C.a Unadjusted and adjusted estimates.b,c

Report of elevated use of alcohol
No Yes Unadjustedb Modelc
n (%) d n (%)d OR 95% CI OR 95% CI
Demographic
Men 94 (71.8) 37 (28.2) 1.129 (0.699–1.823) 1.030 (0.571–3.289)
Age (by years) (Mean SD) 75.6 (7.6) 72.2 (7.2) 0.942 (0.912–0.972) 0.926 (0.891–0.964)
Education ≥ 10 years 135 (50.2)  66 (67.3) 2.342 (1.317–4.163) 1.780 (0.964–3.289)
Not living alone 135 (50.2)  62 (63.3) 0.612 (0.380–0.986) 0.544 (0.308–0.958)
Functional
MMSE score (Mean SD) 25.1 (4.4) 24.9 (4.5) 1.036 (0.976–1.099)
Main diagnoses
MCI and dementia 59 (21.9)  20 (20.4) REF
Psychosis 19 (7.1)  11 (11.2) 1.708 (0.695–4.197)
Affective disorders 124 (46.1) 40 (40.8) 0.952 (0.512–1.769)
Anxiety 33 (12.3) 10 (10.2) 0.894 (0.374–2.135)
Others incl disorder due to abuse 24 (8.9) 14 (14.3) 1.721 (0.749–3.953)
Psychotropic drugs
Antipsychotics N05A 110 (40.9)  41 (41.8) 1.062 (0.650–1.735)
Anxiolytics N03A&N05B 51 (19.0) 21 (21.4) 1.040 (0.650–1.662)
Hypnotics and sedatives N05C 87 (32.3) 33 (33.7) 1.166 (0.659–2.063)
Antidepressants N06A 169 (62.8) 42 (42.9) 0.511 (0.320–0.816) 0.536 (0.313–0.918)
Opioids N02A 19 (7.1)  2 (2.0) 0.274 (0.063–1.199) 0.524 (0.112–2.447)
Adjusted R 2 in %e 15.9
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OR = odds ratio; CI = confidence interval.

Bold numbers are significant associations.

a Reported elevated use of alcohol assess with the short version of the Alcohol Use Disorders Identification Test (AUDIT-C) Cut-off ≥ 3/4 women/men. bAll demographical variables and other independent variables associated p ≤ 0.150 with the outcome in the unadjusted analyses were included in adjusted model. cThe variables presented in the model are adjusted for each other, n = 306 in final model due to missing information. dIf not otherwise specified. eNagelkerke’s R-squared.

Discussion

The prevalence of reported elevated alcohol consumption was about 27% in the present study, based on information from a Norwegian quality registry, including older hospital in-patients in specialist mental healthcare. No difference in prevalence was found by gender. Men living alone more often reported elevated alcohol consumption than men not living alone, while women with a high educational level (≥ 10 years) and women who did not use antidepressants more often reported elevated alcohol consumption than women with less education or who used antidepressants. In adjusted logistic regression analysis, higher age, not living alone and using antidepressants were associated with lower odds for reporting elevated alcohol consumption.

The prevalence of reported elevated alcohol consumption was considerably high in older psychiatry patients and higher compared to what is reported in Norwegian population-based studies (Li et al., 2019; Tevik et al., 2017). However, the prevalence in the present study (27%) was in line with the prevalence found in a previous Norwegian study (23%), including comparable patients (Johannessen, Engedal, Larsen et al., 2017). A comparable high prevalence of elevated alcohol consumption (20%) has also been reported in Australian patients referred to a geriatric medicine hospital (Draper et al., 2015). Elevated alcohol consumption in old age may be a risk factor for mental and physical health problems, but also a way of coping with mental and physical health problems (Caputo et al., 2012; Sorocco & Ferrell, 2006). It is not always easy to know which comes first (Caputo et al., 2012), but older adults are more vulnerable to alcohol consumption than younger adults (Davies & Bowen, 1999; Hallgren et al., 2009; Institute of Alcohol Studies, 2013; National Institute on Alcohol Abuse and Alcoholism, 1998; Squeglia et al., 2014), and detecting elevated consumption among older adults, both in primary and specialist healthcare services, may be health promoting (Wang & Andrade, 2013), if a brief intervention on elevated consumption (Schonfeld et al., 2010) or alcohol abuse treatment is carried out (Dauber, Pogarell, Kraus, & Braun, 2018). Only five per cent of the patients in the present study had disorders due to abuse as their main diagnoses. The prevalence of this diagnosis was comparable to the previously described Norwegian study (Johannessen, Engedal, Larsen, et al., 2017). Of patients with disorders due to abuse, 10 (seven women) had disorders due to alcohol. We do not know whether these figures reflect the situation in the general public. Nevertheless, Norwegian GPs have experienced that many older people have existential needs that are not necessarily met or handled adequately by them, their next of kin, or society, and for some alcohol consumption may seem to be a solution to improve wellbeing (Johannessen, Helvik, Engedal, Ulstein, & Sørlie, 2015). Within this framework, elevated alcohol consumption may arise independently of the type of mental health problems or disorders older people experience. Consequently, it was not unexpected that type of diagnosis was not associated with reported elevated alcohol consumption in this relatively restricted study sample.

In the unadjusted analysis, men living alone more often reported elevated alcohol consumption than those living with someone, while for women, those who took antidepressants were less likely to report elevated alcohol consumption. However, in the regression analysis adjusting for gender and other independent variables, living with someone and using antidepressants were both independently associated with lower odds for reporting elevated alcohol consumption. Population studies of alcohol use among younger adults have, in line with our study, previously reported that divorced and unmarried men and women had a higher alcohol consumption than those living with a partner (Vedøy & Skretting, 2009).

In the present study, no interaction was found between gender and factors associated with the outcome. Thus, we cannot say that there are gender-specific factors for reporting elevated consumption. The association between living alone and elevated consumption is in line with previous studies of home-dwelling older adults (Li et al., 2019), but no association was found in the previous Norwegian study of departments of geriatric psychiatry (Johannessen, Engedal, Larsen, et al., 2017). Thus, we need more insight into the significance of living alone for elevated alcohol consumption in older people with mental health problems. We found that people using antidepressants were less likely to have elevated alcohol consumption. We do not have a clear explanation for this. It may be that people who use antidepressants know that combining these drugs and alcohol is not healthy and therefore did not consume alcohol frequently or did not report elevated consumption. Alternatively, they may have preferred use of antidepressants as a treatment rather than using alcohol. However, we do not know the length of time the various drugs were used or if they were newly prescribed.

This registry study has some limitations. First, as stated above, the timeframe for patients’ use of psychotropic drugs is unclear. Of equal importance is the restricted number of patients who reported alcohol consumption in the registry. We do not know whether there are systematic differences in how AUDIT-C is used in different hospitals, or whether the lack of information is due to the unwillingness of patients to answer questions or the staff not asking questions when reviewing patients, even if it is a part of the standard protocol. A previous study of health personnel who reviewed patients in departments of geriatric psychiatry reported that personnel found it difficult to include questions on alcohol use in their overall review (Johannessen, Engedal, & Helvik, 2017). The low response rate may not only restrict our statistical power, give us less precise estimates of prevalence of elevated alcohol and uncertain associations to elevated alcohol consumption, but may contribute to selection bias. We do not know whether patients who responded to AUDIT-C are different from those who chose not to respond to the questions. Thus, the external validity may be hampered and the study results should not be generalised to cover geriatric psychiatry patients in general. Furthermore, we have relied on the patients’ own reports of alcohol consumption to assess elevated alcohol consumption, which is commonly done, but may be an unreliable source (Crome et al., 2011; Feunekes, van ‘t Veer, van Staveren, & Kok, 1999; May et al., 2018; O’Connell, Chin, Cunningham, & Lawlor, 2003). Moreover, the research design does not enable us to draw any causal conclusion. Although our study has some limitations due to high drop-out rate, it shows that health personnel should increase their awareness of elevated alcohol consumption when assessing older people with psychiatric morbidities, particularly since alcohol consumption and alcohol-related problems in older adults are expected to rise in the years to come (Slagsvold & Hansen, 2017). Future research including older psychiatric patients should pay more attention to use of alcohol.

To sum up, a relatively high proportion of older psychiatric patients reported elevated alcohol consumption, regardless of diagnosis. Older age, living with someone and use of antidepressants were associated with lower odds for elevated alcohol consumption.

Acknowledgements

The authors wish to thank all the participating hospitals for collecting the data and the patients for sharing information and experiences, as well as Norwegian National Advisory Unit on Ageing and Health and Faculty of Medicine and Health Sciences, NTNU, which both supported the study.

Author contributions: Anne-Sofie Helvik has performed the analysis and drafted the manuscript, Aud Johannessen had the research idea, Aud Johannessen and Knut Engedal continuously discussed findings and interpreting of results with Anne-Sofie Helvik. All authors contributed in the manuscript development and the final critical revisions.

Declaration of conflicting interests: The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding: The authors received no financial support for the research, authorship, and/or publication of this article.

Contributor Information

Anne-Sofie Helvik, Department of Public Health and Nursing, Norwegian University of Science and Technology (NTNU), Trondheim; and Norwegian National advisory unit for aging and health, Vestfold Hospital Trust, Trondheim, Norway.

Knut Engedal, Norwegian National advisory unit for aging and health, Vestfold Hospital Trust, Trondheim, Norway.

Aud Johannessen, Norwegian National advisory unit for aging and health, Vestfold Hospital Trust, Trondheim; and University of South-Eastern Norway, Norway.

References

  1. Babor T., De La Fuente J. R., Saunders J., Grant M. (1989). AUDIT: The alcohol use disorders identification test. Guidelines for use in primary healthcare. Geneva, Switzerland: WHO. [Google Scholar]
  2. Bratberg G. H., Wilsnack S. C., Wilsnack R., Håvås-Haugland S., Krokstad S., Sund E. T., Bjørngaard J. H. (2016). Gender differences and gender convergence in alcohol use over the past three decades (1984–2008), The HUNT Study, Norway. BMC Public Health, 16, 723. doi:10.1186/s12889-016-3384-3 [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Caputo F., Vignoli T., Leggio L., Addolorato G., Zoli G., Bernardi M. (2012). Alcohol use disorders in the elderly: a brief overview from epidemiology to treatment options. Experimental Gerontology, 47(6), 411–416. doi:10.1016/j.exger.2012.03.019 [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Crome I., Dar K., Janikiewicz S., Rao T., Tarbuck A. (2011). Our invisible addicts. College Report CR165 . London, UK: Working Group of the Royal College of Psychiatrists. [Google Scholar]
  5. Dauber H., Pogarell O., Kraus L., Braun B. (2018). Older adults in treatment for alcohol use disorders: Service utilisation, patient characteristics and treatment outcomes. Substance Abuse Treatment, Prevention, and Policy, 13(1), 40. doi:10.1186/s13011-018-0176-z [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Davies B., Bowen C. (1999). Total body water and peak alcohol concentration: A comparative study of young, middle-age, and older females. Alcoholism, Clinical and Experimental Research, 23(6), 969–975. [PubMed] [Google Scholar]
  7. Draper B. Ridley N. Johnco C. Withall A. Sim W. Freeman M.…Lintzeris N. (2015). Screening for alcohol and substance use for older people in geriatric hospital and community health settings. International Psychogeriatrics, 27(1), 157–166. doi:10.1017/s1041610214002014 [DOI] [PubMed] [Google Scholar]
  8. Engedal K., Haugen P., Gilje K., Laake P. (1988). Efficacy of short mental tests in the detection of mental impairment in old age. Compr Gerontol A, 2(2), 87–93. [PubMed] [Google Scholar]
  9. Feunekes G. I., van ‘t Veer P, van Staveren W. A., Kok F. J. (1999). Alcohol intake assessment: The sober facts. American Journal of Epidemiology, 150(1), 105–112. doi:10.1093/oxfordjournals.aje.a009909 [DOI] [PubMed] [Google Scholar]
  10. Fillmore K. M., Stockwell T., Chikritzhs T., Bostrom A., Kerr W. (2007). Moderate alcohol use and reduced mortality risk: Systematic error in prospective studies and new hypotheses. Annals of Epidemiology, 17(5 Suppl), S16–S23. doi:10.1016/j.annepidem.2007.01.005 [DOI] [PubMed] [Google Scholar]
  11. Folstein M., Folstein S., McHugh P. (1975). Mni-mental state a practival method for grading the cognitive state of patients for the clinician. J gsychiaf Res, 12, 189–198. http://www.turkpsikiyatri.org/arsiv/mmse_folstein_mchugh.pdf. [DOI] [PubMed] [Google Scholar]
  12. Hallgren M., Högberg P., Andreasson S. (2009). Alcohol consumption among elderly European Union citizens: Health effects, consumption trends and related issues. Retrieved from https://www.folkhalsomyndigheten.se/pagefiles/12338/alcohol-consumption-among-elderly-european-union-citizens-2009.pdf
  13. Hoffmann N. G., Kopak A. M. (2015). How well do the DSM-5 alcohol use disorder designations map to the ICD-10 disorders? Alcoholism, Clinical and Experimental Research, 39(4), 697–701. doi:10.1111/acer.12685 [DOI] [PubMed] [Google Scholar]
  14. Holdsworth C., Frisher M., Mendonca M., De Oliveiria C., Pikhart H., Shelton N. (2017). Lifecourse transitions, gender and drinking in later life. Ageing and Society, 37(3), 462–494. doi:10.1017/s0144686x15001178 [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Institute of Alcohol Studies. (2013). Older people and alcohol. Factsheet. London, UK: Institute of Alcohol Studies. Retrieved from http://www.ias.org.uk/uploads/pdf/Factsheets/Alcohol%20and%20older%20people%20FS%20May%202013.pdf [Google Scholar]
  16. Johannessen A., Engedal K., Helvik A.-S. (2017). Assessment of alcohol and psychotropic drug use among old-age psychiatric patients in Norway: Experiences of health professionals. Nordic Studies on Alcohol and Drugs, 34%, 243–254. [DOI] [PMC free article] [PubMed] [Google Scholar]
  17. Johannessen A., Engedal K., Larsen M., Stelander L. T., Helvik A.-S. (2017). Alcohol and prescribed psychotropic drug use among patients admitted to a department of old-age psychiatry in Norway. Nordic Studies on Alcohol and Drugs, 34(1), 57–71. doi:10.1177/1455072516682642 [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Johannessen A., Helvik A.-S., Engedal K., Ulstein I., Sørlie V. (2015). Prescribers of psychotropic drugs experiences and reflections on use and misuse of alcohol and psychotropic drugs among older people: A qualitative study. Quality in Primary Care, 23(3), 134–140. [Google Scholar]
  19. Korrapati M., Vestal R. (1995). Alcohol and medications in the elderly: Complex interactions. In Beresford T., Gomberg E., Gomberg E. (Eds.), Alcohol and aging. New York, NY: Oxford University Press. [Google Scholar]
  20. Kristiansen K. M., Engedal K. (2013). New quality registry in geriatric psychiatry. Tidsskr Nor Laegeforen, 133(7), 737–738. doi:10.4045/tidsskr.13.0048 [DOI] [PubMed] [Google Scholar]
  21. Kuzma E., Llewellyn D. J., Langa K. M., Wallace R. B., Lang I. A. (2014). History of alcohol use disorders and risk of severe cognitive impairment: a 19-year prospective cohort study. The American Journal of Geriatric Psychiatry, 22(10), 1047–1054. [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. Langballe E. M. Ask H. Holmen J. Stordal E. Saltvedt I. Selbaek G.…Tambs K. (2015). Alcohol consumption and risk of dementia up to 27 years later in a large, population-based sample: The HUNT study, Norway. European Journal of Epidemiology, 30(9), 1049–1056. doi:10.1007/s10654-015-0029-2 [DOI] [PMC free article] [PubMed] [Google Scholar]
  23. Li J., Wu B., Selbaek G., Krokstad S., Helvik A. S. (2017). Factors associated with consumption of alcohol in older adults: A comparison between two cultures, China and Norway: The CLHLS and the HUNT-study. BMC Geriatrics, 17(1), 172. doi:10.1186/s12877-017-0562-9 [DOI] [PMC free article] [PubMed] [Google Scholar]
  24. Li J., Wu B., Tevik K., Krokstad S., Helvik A. S. (2019). Factors associated with elevated consumption of alcohol in older adults-comparison between China and Norway: The CLHLS and the HUNT Study. BMJ Open, 9(8), e028646. doi:10.1136/bmjopen-2018-028646 [DOI] [PMC free article] [PubMed] [Google Scholar]
  25. May P. A. Hasken J. M. De Vries M. M. Marais A. S. Stegall J. M. Marsden D.…Tabachnick B. (2018). A utilitarian comparison of two alcohol use biomarkers with self-reported drinking history collected in antenatal clinics. Reproductive Toxicology, 77, 25–32. doi:10.1016/j.reprotox.2018.02.002 [DOI] [PMC free article] [PubMed] [Google Scholar]
  26. Moos R. H., Brennan P. L., Schutte K. K., Moos B. S. (2004). High-risk alcohol consumption and late-life alcohol use problems. American Journal of Public Health, 94(11), 1985–1991. [DOI] [PMC free article] [PubMed] [Google Scholar]
  27. National Institute on Alcohol Abuse and Alcoholism (NIAAA). (1998). Alcohol and Aging. Alcohol Alert. Rockville, MD: NIAAA. Retrieved from https://pubs.niaaa.nih.gov/publications/aa40.htm
  28. O’Connell H., Chin A. V., Cunningham C., Lawlor B. (2003). Alcohol use disorders in elderly people: Redefining an age old problem in old age. BMJ, 327(7416), 664–667. doi:10.1136/bmj.327.7416.664 [DOI] [PMC free article] [PubMed] [Google Scholar]
  29. Schonfeld L., King-Kallimanis B. L., Duchene D. M., Etheridge R. L., Herrera J. R., Barry K. L., Lynn N. (2010). Screening and brief intervention for substance misuse among older adults: The Florida BRITE project. American Journal of Public Health, 100(1), 108–114. doi:10.2105/ajph.2008.149534 [DOI] [PMC free article] [PubMed] [Google Scholar]
  30. Slagsvold B., Hansen T. (2017). Future elderly with higher education: Some consequences for mental health. Tidsskrift for Norsk psykologforening, 55(1), 36–45. [Google Scholar]
  31. Sorocco K. H., Ferrell S. W. (2006). Alcohol use among older adults. Journal of General Psychology, 133(4), 453–467. doi:10.3200/genp.133.4.453-467 [DOI] [PubMed] [Google Scholar]
  32. Squeglia L., Boissoneault J., Van Skike C., Nixon S., Matthews D. (2014). Age-related effects of alcohol from adolescent, adult, and aged populations using human and animal models. Alcoholism, Clinical and Experimental Research, 38(10), 2509–2516. [DOI] [PMC free article] [PubMed] [Google Scholar]
  33. Støver M., Bratberg G., Nordfjørn T., Krokstad S. (2012). Use of alcohol and prescription drugs among elderly (60+) in Norway. The HUNT study, Norway [Bruk av alkohol og medikamenter blant eldre (60+) i Norge. Heløseundersøkelsen i Nord-Trøndelag]. Retrieved from https://www.ntnu.no/c/document_library/get_file?uuid=5e76ea20-86b6-4629-a50c-2989b89e8191&groupId=10304
  34. Strobel C., Engedal K. (2008). MMSE-NR: The standardized Norwegian MMSE. Oslo, Norway: Norwegian National Advisory Unit on Ageing and Health. [Google Scholar]
  35. Tevik K., Selbaek G., Engedal K., Seim A., Krokstad S., Helvik A. S. (2017). Use of alcohol and drugs with addiction potential among older women and men in a population-based study: The Nord-Trondelag Health Study 2006-2008 (HUNT3). PLoS One, 12(9), e0184428. doi:10.1371/journal.pone.0184428 [DOI] [PMC free article] [PubMed] [Google Scholar]
  36. Tevik K., Selbaek G., Engedal K., Seim A., Krokstad S., Helvik A. S. (2019). Factors associated with alcohol consumption and prescribed drugs with addiction potential among older women and men: The Nord-Trondelag health study (HUNT2 and HUNT3), Norway, a population-based longitudinal study. BMC Geriatrics, 19(1), 113. doi:10.1186/s12877-019-1114-2 [DOI] [PMC free article] [PubMed] [Google Scholar]
  37. Vedøy T. F., Skretting A. (2009). Bruk av alkohol blant kvinner. Data fra ulike surveyundersøkelser [Use of alcohol among women. Data from several surveys]. Retrieved from https://fhi.brage.unit.no/fhi-xmlui/bitstream/handle/11250/276062/sirusrap.4.09.pdf?sequence=3
  38. Wang Y. P., Andrade L. H. (2013). Epidemiology of alcohol and drug use in the elderly. Current Opinion in Psychiatry, 26(4), 343–348. doi:10.1097/YCO.0b013e328360eafd [DOI] [PubMed] [Google Scholar]
  39. WCC+DSM. (2019). WHO Collaborating Centre for Drug Statistics Methodology. ATC/DDD Index. Retrieved from https://www.whocc.no/atc_ddd_index/
  40. World Health Organization. (2010). International statistical classification of diseases and related health problems: Instruction manual (Vol. 2).: WHO; Retrived from https://www.who.int/classifications/icd/ICD10Volume2_en_2010.pdf. [Google Scholar]
  41. World Health Organization. (2004). The global burden of disease. Retrieved from http://www.who.int/healthinfo/global_burden_disease/GBD_report_2004update_full.pdf
  42. World Medical Association (WMA). (2013). WMA Declaration of Helsinki - Ethical principles for medical research involving human subjects. Retrieved from https://www.wma.net/policies-post/wma-declaration-of-helsinki-ethical-principles-for-medical-research-involving-human-subjects/ [DOI] [PubMed]

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