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Drugs and Alcohol Today
Prevalence of alcohol and medication use among elderly individuals in Spain
Ismael San Mauro Martin, Juanjo Nava Mateo, Jesús Ortiz Rincón, Marta Villanueva Nieto, Elena Ávila Díaz, Sara Sanz
Rojo, Licia de la Calle, Yaiza Quevedo Santos, Paloma Elortegui Pascual, Víctor Paredes Barato, Sara López Oliva, Elena
Garicano Vilar,
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To cite this document:
Ismael San Mauro Martin, Juanjo Nava Mateo, Jesús Ortiz Rincón, Marta Villanueva Nieto, Elena Ávila Díaz, Sara Sanz
Rojo, Licia de la Calle, Yaiza Quevedo Santos, Paloma Elortegui Pascual, Víctor Paredes Barato, Sara López Oliva, Elena
Garicano Vilar, (2018) "Prevalence of alcohol and medication use among elderly individuals in Spain", Drugs and Alcohol
Today, Vol. 18 Issue: 3, pp.198-204, https://doi.org/10.1108/DAT-11-2017-0060
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Prevalence of alcohol and medication use
among elderly individuals in Spain
Ismael San Mauro Martin, Juanjo Nava Mateo, Jesús Ortiz Rincón, Marta Villanueva Nieto,
Elena Ávila Díaz, Sara Sanz Rojo, Licia de la Calle, Yaiza Quevedo Santos,
Paloma Elortegui Pascual, Víctor Paredes Barato, Sara López Oliva and Elena Garicano Vilar
Abstract
Purpose –The world’s aging population has led to a greater use of prescription and non-prescription
medication by the elderly. Besides, older drinkers consume alcohol often regardless of the medication they
consume. The purpose of this paper is to examine the intake of medication andalcohol simultaneously in a group
of elderly in the community of Madrid, and the possible differences in consumption between men and women.
Design/methodology/approach –An observational cross-sectional study of 342 elderly in Madrid, aged
65–96 years was conducted, including the collection of anthropometric data (weight, height, waist circumference,
BMI), information about the quantity of daily alcohol intake and medication taken from each subject.
Findings –A high percentage of the sample used medication, especially women. A smaller percentage of the
sample consumed alcohol, being more frequent among men and decreasing with age. Inaddition, almost half of
the sample (46.4 percent) combined medication intake with alcohol, especially men. High alcohol consumption
was observed simultaneously in those subjects taking medication; in addition to the non-perception of the real
risk to health. Statistically significant sex differences were observed, since men drank more, including when
taking medication; although women may be more vulnerable to harm derived from alcohol.
Originality/value –This study contributed to estimate the risk to the public health of old people, and the
integrity of their health, by observing the consumption of both medication and alcohol, given that medication
taken in conjunction with alcohol can cause adverse side effects.
Keywords Alcohol, Elderly, Lifestyle, Public health, Medicine, Pharmacokinetic
Paper type Research paper
1. Introduction
The proportion and number of the elderly is experiencing growth in the world. One of the most
significant social transformations of the twenty-first century is this increasing share of older persons
in the population, with implications for nearly all sectors of society (United Nations, 2015).
The daily consumption of small-moderate volumes of alcohol (one to two glasses in women,
three to four glasses in men), in particular of red wine, has been related with a decreased risk of
cardiovascular disease (Ministerio de Economia y Competitividad, 2014), cancer, all-cause
mortality and with longer life expectancy, but it could be dependent on several lifestyle variables
and health indicators (Gea et al., 2014). The elderly hold a higher risk of cardiovascular disease, in
which the risk-benefit ratio is lower; therefore, drug interactions in a polymedicated old person
are probabilistically higher even with a moderate intake of alcohol.
8 percent of the world’s population, 524m people, was aged 65 or older in 2010. This figure is
expected to triple by 2050 to about 1.5bn (Suzman and Beard, 2011).
According to data from the Continuous Register (INE) on January 2016, there were 8,657,705
elderly people in Spain (65 and over), 18.4 percent of the total population (46,557,008).
The predominant sex in old age is the female. There were 4,940,008 women and 3,717,697 men
(Abellán García et al., 2017).
Received 6 March 2018
Revised 28 May 2018
Accepted 29 May 2018
The authors would like to thank
Agencia Madrileña de Atención
Social (AMAS), Consejería de
Políticas Sociales y Familia,
Comunidad de Madrid. No
sources of funding were provided
for this paper. The authors have
received no grants in support of
this research work. The authors
declare no conflict of interest.
Ismael San Mauro Martin is
based at Research Centers in
Nutrition and Health,
Madrid, Spain.
Juanjo Nava Mateo is based at
Hospital Campo Aranuelo,
Navalmoral de la Mata, Spain.
Jesús Ortiz Rincón is based at
the University College Hospital,
London, UK.
Marta Villanueva Nieto,
Elena Ávila Díaz,
Sara Sanz Rojo, Licia de la Calle,
Yaiza Quevedo Santos,
Paloma Elortegui Pascual,
Víctor Paredes Barato,
Sara López Oliva and
Elena Garicano Vilar are all
based at Research Centers in
Nutrition and Health, Madrid,
Spain.
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This remarkable phenomenon is being driven by improvements in longevity and declines in
fertility (Suzman and Beard, 2011). National infrastructures, particularly health systems, will be
challenged by the sheer number of people reaching older ages. The rise of chronic and
degenerative diseases in countries throughout the world is one of the major epidemiologic trends
of the current century (Suzman and Beard, 2011).
There is evidence that today’s older people may be relatively heavier drinkers than previous
generations, although historically older people have tended to drink less than any other age group
(Institute of Alcohol Studies, 2013). Older drinkers consume alcohol far more often than any other
age group, despite drinking comparatively little. The body of an older person is less able to clear
the same levels of alcohol as in previous years, so alcohol remains in the body longer, producing a
cumulative effect. “The rising number of alcohol-related admissions/discharges and deaths
among those aged 65 years and over highlights the health problems underlying their
consumption habits”(Institute of Alcohol Studies, 2013).
This process has led to longer pharmacological treatment times and, consequently, to the use of
prescription and non-prescription medication by the elderly ( Jerez-Roig et al., 2014). Although
drug therapy often results in beneficial effects and improves functional status, drug-related illness
is a significant health problem (Tamblyn, 1996).
The three groups of medication that are most commonly prescribed in the elderly are cardiovascular
medication, psychotropic medication and non-steroidal anti-inflammatory medication (NSAIDs)
(Tamblyn, 1996). It has been estimated that the percentage of persons, 65 years and over, using at
least one prescription drug in the past 30 days was 89.8 percent, using three or more prescription
was 64.8 percent and using five or more prescription medication was 39.1 percent (in 2009–2012)
(Centers for Disease Control and Prevention, 2017). Of those drug prescriptions, 31.2 percent were
β-adrenergic blocking agents, 23.3 percent were ACE inhibitors, 17.3 percent were calcium channel
blocking agents and 12 percent were angiotensin-II inhibitors (all for high blood pressure and heart
disease), 19 percent were anti-diabetic agents, 16.3 percent were anti-coagulants or anti-platelet
agents ( for blood clot prevention) and 13.1 percent were antihypertensive combinations or
anti-arrhythmic agents, among others (National Center for Health Statistics, 2016).
In addition, alterations inherent in the senescence process can cause damage to the physical and
mental health of the elderly when using non-prescription medication, important fact considering
that the elderly can resort to self-medication to maintain health or ameliorate symptoms
( Jerez-Roig et al., 2014). Besides, it could lead to not stop consuming certain foods or drinks,
such as alcohol, when consuming medication.
Adverse side effects can be caused by prescribed medication taken in conjunction with alcohol.
Older people are usually advised against drinking when taking other medication. The medication’s
impact in a regular drinker may be diminished by the simultaneous ingestion of alcohol with other
medication, or may increase the body’s sensitivity to the other substance, depending on its
strength. The rate of metabolism of medicationon alcohol can be depressed if both substances are
combined, thus altering their effect on the body (Palacio-Vieira et al., 2012). Alcohol is metabolized
by alcohol dehydrogenase and cytochrome P450 (CYP2E1), so medication that affects this
cytochrome will have interactions with alcohol (Chan and Anderson, 2014).
For all of the above, we estimate a risk to the public health of people, and the integrity of their
health, if we observe the consumption of both medication and alcohol.
This study aimed to examine the concurrent use of medication and alcohol in a group of elderly in
the community of Madrid. It also aimed to study the possible differences in consumption of both,
alcohol and medication, between men and women.
2. Materials and methods
2.1 Study population
A sample of 342 subjects, of both sexes (72.8 percent women and 27.2 percent men), aged
65–96 years, from the Community of Madrid was studied along 2016–2017. The sample was
enrolled in a geographic division from 22 residences for the elderly in all regions of Madrid, north,
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south, east, west and the city center. Inclusion criteria were subjects over 65 years old, of
both sexes, no severe disease, who agreed to participate voluntarily and filled in the informed
consent. Participants who did not meet inclusion criteria (n¼38) complete all questionnaires or
were absent on the day of the survey were excluded. Study sample was finally constituted
by 304 subjects. Helsinki rules were followed and the rights of the all participants respected.
All subjects signed an informed consent to participate in the project, which was handed in
by health professionals.
2.2 Study factors
Anthropometric measurements. Weight, height, BMI and waist circumference of each participant
was measured (Table I). Weight and BMI were determined through an electrical bioimpedance
analyzer TANITA model BP-601, with a range of 0.1–150 kg; and a flexible non-elastic, metallic
measuring tape, ranged from 0.1 mm to 150 cm was used to measure waist circumference.
Height was measured with a SECA mobile rod height meter with a precision of 1 mm, with
subjects standing barefoot, according to the WHO (World Health Organization, 2008) protocol.
BMI was calculated based on weight and height according to the Quetelet index (Durnin and
Fidanza, 1985). To define cut-off points in BMI, we resorted to Spanish Society of Geriatrics and
Gerontology and Spanish Society of Parenteral and Enteral Nutrition guidelines for nutritional
assessment in elderly (Cuesta and Rodríguez, 2006). BMI o27 was considered underweight and
normal weight, BMIW27 was considered overweight and obese.
Alcohol intake. Information about the quantity of total daily alcohol intake (in milliliters or liters) from
different types of beverages, wine, beer, distilled spirits and liquors was collected. The
questionnaire assessed the type of drink consumed, frequency of consumption and the volumes
of beverages ingested using standard portion sizes. Total alcohol intake was defined as the sum
of all these beverages.
Medication intake. Data on medication were registered in an ad hoc questionnaire. Each
participant indicated their consumption of prescribed medication for pain, allergy, heart, blood
pressure, stomach, depression, diabetes, cholesterol or other ailments; or if they did not
consume any medication. Data were collected by trained nutritionists and dieticians,
standardizing the data collection protocol and monitoring the study.
2.3 Statistical analysis
The statistical analysis entailed descriptive analyses, presenting the results in means, standard
deviation and percentages. We used parametric statistical tests such as Student’st-test to
analyze the differences between the means in two groups of quantitative variables and a χ
2
test
for non-parametric qualitative variables. A value of po0.05 was considered a significant
difference. Analysis of the data collected was processed with system SPSS® (version 20).
3. Results
The sample consisted of 304 people, 72.8 percent women and 27.2 percent men, aged 65–96
years, with a mean age of 75.22 ±6.47 years (Table I). In total, 59.3 percent of subjects had a BMI
Table I Personal and anthropometric data of the sample
Total Men Women
Mean ±SD Mean ±SD Mean ±SD
Age (years) 75.22 ±6.47 75.01 ±5.65 75.29 ±6.74
Weight (kg) 70.36±12.81 77.1 ±12.09 67.68 ±11.73
Height (m) 1.56 ±0.86 1.66 ±0.65 1.53 ±0.68
BMI (kg/m
2
) 28.67 ±4.59 28.09 ±3.7 28.76 ±4.74
Waist circumference (cm) 96.55±13.63 102.63±11.62 94.1 ±13.43
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over 27 that means overweight or obese. In total, 61.6 percent of women and 50.7 percent of
men presented BMIW27.
Figure 1 shows the percentages, according to sex, of the consumption of medication and alcohol
together or separately. A very high percentage of the sample (92.1 percent) used medication,
especially women. A smaller percentage of the sample (50.9 percent) is an alcohol consumer,
being the consumption more frequent among men. In addition, more than half of men
(67.1 percent) consume alcohol and medication in combination (Table II).
When analyzing data, sorted by age ranges, alcohol and medication consumption decreased with
age. Subjects aged 60–69 years incurred in a higher consumption of alcohol and medication, both
separately or together. No statistically significant differences were found (p¼0.656, p¼0.620)
between age groups and alcohol intake and drug+alcohol intake, respectively (Table III).
No statistically significant differences (p¼0.613) were found when analyzing the correlation between
drug and alcohol intake. Only 3.5 percent did not consume either medication or alcohol, however,
almost half of the sample (46.4 percent) combines medication intake with alcohol (Table IV).
4. Discussion
Alcohol-related harm among elderly people is due to somewhat different factors than
alcohol-related harm among young people. While alcohol consumption (measured using two
Figure 1 Percentage of alcohol intake vs alcohol and medication intake, by sex
Alcohol intake
Alcohol No alcohol
0
20
40
60
80
Total Men Women
Alcohol and medication intake
Alcohol +
medication
No alcohol +
no medication
0
20
40
60
80
Total Men Women
Percentage (%)
Percentage (%)
Table II Medication and alcohol intake, by sex: descriptive data
Total Men Women p-value
Medication intake (%, yes) 92.1 89.5 92.8 –
Alcohol intake (%, yes) 50.9 75.3 43.4 o0.001
Medication and alcohol intake (%, yes) 46.4 67.1 40 o0.001
Table III Relationship between age and alcohol consumption, and with medication and alcohol consumption together
Age (years) Alcohol (%, yes) Alcohol (p-value) Medication and alcohol (%, yes) Medication and alcohol (p-value)
60–69 54.3 0.656 49.7 0.620
70–79 49.7 48.3
⩾80 47.7 42.0
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common indicators: alcohol per capita consumption or alcohol consumption in grams of pure
alcohol per person per day) generally declines with age, older drinkers typically consume alcohol
more frequently (on a daily basis) than other age groups (World Health Organization, 2014).
Older peoples’bodies are typically less able to handle the same patterns and levels of alcohol
consumption as in previous life years, leading to a high burden from unintentional injuries
(World Health Organization, 2014).
Alcohol use may increase the risk for disability related to balance problems, falls and serious
injury, especially in older adults, and may also worsen or trigger certain medical conditions
(WebMD, 2017). Harmful alcohol–medication interactions are of high risk for older people in
particular. Aging slows the body’s ability to metabolize alcohol as quickly as younger adults do,
so alcohol stays in their systems longer and has a greater potential to interact with medication
(National Institute on Alcohol Abuse and Alcoholism, 2003).
Extremely prevalent is also the use of non-prescription and prescription medication, as well as
herbal remedies. In total, 75 percent of the older Spanish take some medicine each day (1.92 per
person per day), which is directly related to age, especially in the persons above the age of 80,
and the number of illnesses (Vega Quiroga et al., 1996), many of the medicines react adversely
with alcohol. The problems associated with mixing alcohol and medication are certain to
increase, as the population ages (WebMD, 2017).
Interactions between medication and alcohol may alter the metabolism or effects of alcohol and/
or the drug and can occur even at moderate drinking levels, resulting in adverse health effects for
the drinker (Weathermon and Crabb, 1999).
Antibiotics, antihistamines, barbiturates, antidepressants, benzodiazepines, histamine H2 receptor
antagonists, opioids, muscle relaxants, nonnarcotic pain medication and anti-inflammatory agents
and warfarin, all prescription medication, can interact with alcohol. Examples of commonly used
prescription medication associated with serious alcohol interactions include heart medication
(β-adrenergic blocking agents, ACE inhibitors, calcium channel blockers, angiotensin-II inhibitors),
which can cause rapid heartbeat and sudden changes in blood pressure and an increase of side
effects; NSAIDs, which can increase the risk of heart attacks, strokes, liver toxicity, ulcers and
stomach bleeding; blood-thinning medication, which can lead to internal bleeding; and sleep
medication, which can lead to impaired breathing, motor control and unusual behavior (WebMD,
2017). Erythromycin (antibiotics) may increase gastric emptying, leading to faster alcohol absorption
in the small intestine, and alcohol increases the risk of isoniazid-related liver disease. Alcohol
enhances the effects of antihistamines on the central nervous system, such as drowsiness, sedation
and decreased motor skills; and these interactions are more pronounced in elderly people. Chronic
alcohol intake increases barbiturate metabolism by cytochrome P450 and alcohol enhances the
sedative and hypnotic effects on the central nervous system. Alcohol also enhances the effects of
benzodiazepines and opioids on the CNS. Histamine H2 receptor antagonists inhibit ADH in the
stomach, thereby reducing alcohol first-pass metabolism, as well as increase gastric emptying. As a
result, BALs are higher than expected for a given alcohol dose; this effect increases over time. Alcohol
consumption enhances the impairment of physical abilities and increases sedation after the intake of
muscle relaxants. Alcohol consumption increases the risk of sedation and a sudden drop in blood
pressure when a person stands if antidepressants are taken. Anti-inflammatory agents taken with
alcohol increase the associated risk of gastrointestinal bleeding (Weathermon and Crabb, 1999).
The vulnerability of women to alcohol-related harm, well evidence based, is a major public health
concern because alcohol use among women has been increasing steadily in line with changing
gender roles and economic development (Grucza et al., 2008; Wilsnack et al., 2013).
Table IV Drug and alcohol intake: descriptive data
Medication intake No medication intake p-value (χ
2
)
Alcohol intake (%, yes) 46.4 4.4 0.613
No alcohol intake (%, yes) 45.5 3.5
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On the other hand, 7.6 percent of global male deaths in 2012 were attributable to alcohol,
compared to 4 percent of female deaths. Men are less often abstainers, drink in larger quantities
and more frequently compared to women (Nolen-Hoeksema, 2004). However, the same level of
consumption leads to more pronounced health outcomes for women such as cardiovascular
diseases, gastrointestinal diseases or cancers (Rehm et al., 2010).
Because of the rapidly aging population in many countries worldwide, the alcohol-related burden
of disease among older age groups is an increasing public health concern (World Health
Organization, 2014).
It is possible that the sample presents more morbidity than a pure community sample (and/or) more
enforcement of taking the medication, as the sample members were recruited in particular specialized
residences. Also it is possible that in these facilities, the use of alcohol could be conditioned by the
rules of the residences and be somewhat more moderate than alcohol use in a pure community
sample. On the other hand, this setting allowed a good recording of medicines and alcohol use. In any
case, this study contributed to estimate the risk to the public health of old people, and the integrity of
their health, by observing the consumption of both medication and alcohol. Given that medication
taken in conjunction with alcohol can cause adverse side effects, and that the world’saging
population has led to a greater use of medication by the elderly, the often consumption of alcohol by
older drinkers, regardless of the medication they consume, should be taken into account.
Further research is intended, for instance a multicenter and/or multiethnic clinical trial with a
bigger sample that would allow a more detailed description of patterns of medicines use with
more risk of interaction with alcohol.
5. Conclusions
High alcohol consumption was observed simultaneously in those subjects taking medication; in
addition to the non-perception of the real risk to health. No statistically significant differences were
observed in a lower alcohol intake among those taking or not taking medication. Statistically
significant sex differences were observed, since men drank more, including when taking medication.
Measures of public health information and awareness are necessary to avoid observing our results.
It is important to read warning labels on all medication, although most medications are safe and
effective when used as directed. Many popular medications contain more than one ingredient
that can adversely interact with alcohol.
In light of the prevalence of alcohol consumption, it is essential that pharmacists and doctors
enlighten their patients about drug-alcohol interactions (Noureldin et al., 2010).
The study sample was a convenience sample, which served as the limitation of this study.
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Corresponding author
Ismael San Mauro Martin can be contacted at: info@grupocinusa.es
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