Problem Drinking and Depression Among Older Adults with Multiple Chronic Health Conditions

Background and Purpose: The consequences of problem drinking among older adults include numerous health problems and are exacerbated by the presence of mental health problems including depression. Furthermore, as this group ages, up to 65% may experience multiple chronic health conditions (MCC), which is related to a greater likelihood of increased mortality, disability, and poor quality of life. However, few studies have examined the intersection of depression and alcohol use among older adults with MCC. Thus, the goal of this study is to examine alcohol use among older adults with MCC, and to examine whether older adults with MCC and depression comprise a group of individuals with elevated risk for problem drinking.

Methods: The current study utilizes Wave 1 data from the National Social Life, Health and Aging Project, which is a community-based nationally representative survey of over 3,000 participants between the ages of 57 and 85 years. This study samples NSHAP respondents who identified as active alcohol consumers (N = 1,643). Participants were assessed for whether they currently experience MCC. Participants also completed the CAGE (a previously validated measure associated problem drinking), CES-D (a previously validated measure to assess the presence of depression), as well as other social and health measures including race/ethnicity, marital status, age, gender, education, and annual household income, physical health and medication usage for depression.

Results:  Among NSHAP respondents, 12.3% were identified as problem drinkers, 64.1% reported MCC, and 20.3% were identified as having symptoms associated with depression. However, individuals who were problem drinkers were more likely to report symptoms associated with depression. A logistic regression examining the main effect and interaction of MCC and depression on problem drinking, controlling for other social and health measures showed that men, older adults aged between 57 and 65, and divorced/separated individuals reported lower odds of problem drinking. The main effects of major depression and MCC were not significant predictors of problem drinking. However, the product term created to examine whether depression moderates the relationship between MCC and problem drinking was significant. Follow up analyses showed that among individuals with MCC, those who experience depression were five times more likely to engage in problem drinking compared to individuals with MCC and no depression. Among individuals with no MCC, there were no differences in the probability for problem drinking between those with major depression and those without.

Conclusion and Implications: Effectively treating individuals with MCC requires an understanding that specific factors among MCC populations can serve as important indicators for additional health-related problems. Here, we have identified that older adults most at-risk for problem drinking include the combined presence of MCC and depression. Screening and effective interventions remain a priority in the effective treatment and management of problem drinking among individuals with MCC. With the availability of rapid problem drinking screening tools and the potential to integrated alcohol use within MCC self-management interventions, there is high potential to make considerable gains in improving the lives of persons with MCC.