Alcohol Consumption Among Older Adults in Northern Thailand
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Original Research Article 99 ALCOHOL CONSUMPTION AMONG OLDER ADULTS IN NORTHERN THAILAND Torranong Philalai1, 2, Cheerawit Rattanapan1, Orapin Laosee1, * 1 ASEAN Institute for Health Development, Mahidol University, Salaya, Nakorn Pathom, 73170, Thailand 2 The Healthcare Accreditation Institute (Public Organization), Nonthaburi, 11000, Thailand ABSTRACT: Background: Alcohol consumption of the older Thai adult population is important to understand for health promotion plans in district health systems. This study aimed to examine the prevalence of alcohol consumption and associated factors among older adults at community level to understand current situation for target health promotion policy implementation among this vulnerable group. Methods: A household cross-sectional study was conducted for Thai adults aged 50 years and older in Wiang Pa Pao district, Chiang Rai Province, Thailand from January to March 2016. Multi-stage cluster sampling was used to select the respondents from seven sub-districts. Three hundred and sixteen participants were approached and interviewed by trained research assistants. Data were analyzed by Bivariate, and multiple logistic regressions. Results: The majority of respondents (53.7%) were aged 60 years and over (Median = 60 years). The prevalence of current alcohol consumption over the past three months was 23.9%. The study identified factors associated with current alcohol consumption as aged between 50 to 59 years old, being male, current tobacco use, negative to moderate perceptions of current health status, low problem of sleep, high frequency of social contact, low frequency of modern medicine provider contact, and herbal medicine provider contact (p-value < 0.05). By multiple logistic regression, aged between 50 to 59 years old (AdjOR 1.98; 95% CI=1.09-3.59), being male (AdjOR 2.46; 95% CI=1.35-4.47), current tobacco use (AdjOR 6.29; 95% CI=2.56-15.44), high frequency of social contact (AdjOR 3.18; 95% CI=1.70-5.94), and low frequency of herbal medicine providers contact (AdjOR 2.78; 95% CI=1.01-7.68) were observed to be strong predictors of current alcohol consumption when adjusted for other factors. Conclusions: High prevalence of alcohol consumption has been highlighted in this study. Our findings could help to understand current situation targeting promotion policy implementation among this vulnerable group in the district of northern Thailand. Keywords: Alcohol consumption; Aging, Older adults; Risk factors; Thailand DOI: 10.14456/jhr.2017.13 Received: May 2016; Accepted: August 2016 INTRODUCTION significantly increasing risk factor for the global Nowadays, over 15% of the global populations burden of mortality, representing 2.8% of all deaths are over 50 years old and this will increase to 23% and 3.0% of all potential years of life lost (PYLL) in by 2030. A previous study showed that the absolute 2010 [3]. Previous studies reported that the trend of number of older adults with alcohol use disorders high risk alcohol consumption was increasing was increasing [1]. The Health Survey for England among older adult patients in primary care 2008 [2] reported a 3.6-fold increase in alcohol nationwide and was now considered as a public consumption in the last five years for people aged 65 health concern [4, 5]. Few studies have investigated years and over. Moreover, the 2013 review on alcohol use among older adults in low and middle alcohol research found that alcohol was a income countries. Research in India indicated that 7.7% of cases were hazardous and 9.2% were * Correspondence to: Orapin Laosee dependent and 2.4% were harmful drinkers [6]. The E-mail: [email protected] Thai National Survey in 2011 reported that 24.7% of Philalai T, Rattanapan C, Laosee O. Alcohol consumption among older adults in northern Thailand. Cite this article as: J Health Res. 2017; 31(2): 99-107. DOI: 10.14456/jhr.2017.13 http://www.jhealthres.org J Health Res vol.31 no.2 April 2017 100 people aged 60 years and over consumed alcohol older were obtained from January to March 2016. [7]. Sampling and recruitment Among the elderly, alcohol consumption was a Multi-stage cluster sampling was applied to major contributing factor for the occurrence of seven sub-districts of Wiang Pa Pao district, Chiang traumatic brain injuries, hypertension, anxiety and Rai, Thailand. The sample size was estimated using the worsening of chronic illnesses such as insomnia a confidence interval of 95%, an acceptance error of and depression with less social support during recent 5%, and estimate proportion of older adults who decades [8-10]. Consuming alcohol is more toxic in used alcohol of 0.25. The required minimum sample the ageing organism. Age related changes in size was determined at 316. Twenty-two villages in metabolism, distribution and elimination [11]. The seven sub-districts were selected and participants effects of alcohol may be increased in the elderly were recruited by simple random sampling. Trained because of pharmacologic changes associated with research assistants who work in primary care units ageing [12]. were trained for household data collection. Informed Socio-demographic factors were found to be consent was obtained before each interview. associated with alcohol consumption among elderly people including age, sex, marital status, education Research instrument level, race, religion and socioeconomic status [13- A face-to-face interview questionnaire was 18]. Kirchner et al. [18] reported that heavy drinking adapted from The World Health Organization’s was associated with depression and anxiety and less Ultra-rapid Alcohol, Smoking and Substance social support. Moreover, a recent review suggested Involvement Screening Test (ASSIT-lite) and the that increased attention must be focused on the Study on Global Ageing (SAGE) [26]. It consisted interaction between alcohol use, coping with stress of six parts, 1) general characteristics, 2) alcohol and depressive illness [19]. Older adults who have consumption behaviors, 3) current tobacco use, 4) health problems and use alcohol to manage pain are health state-related factors, 5) social networks, and at elevated risk to contract drinking problems [20]. 6) health service utilization. The questionnaire was In addition, few studies have suggested that the revised for validity and reliability according to the strongest predictor of alcohol misuse was tobacco expert comments and suggestions. addiction [5, 21]. Part 1 consisted of four questions regarding the The 2015 Thais alcohol consumption annual socio-demographic characteristics of the respondents report was shown prevalence 18.41% of Thais older which included age, gender, current marital status, adult were current alcohol use, 22.54% ever drink and education level. Part 2 was based on their but not drink in the past 12 months, and 59.05% response regarding alcohol consumption during the were ex-drinkers and lifetime abstainers [22]. three months prior to this study, modified from the Siviroj, et al. [23] reported that 64% of adults aged ASSIST-Lite version. The respondents were over 50 years in the northern Thailand were lifetime assessed with the question: “Did you have a drink alcohol users, 25.2% were daily alcohol users and containing alcohol?” The response choices included 13.1% engaged in drinking and driving. In Thailand, “yes” and “no”. Part 3 concerned current tobacco the difference association of age and gender with use which is an important reinforcing factor hazardous–harmful or probably dependent drinkers associated with alcohol consumption [5, 21]. This has been documented [23, 24]. It is hard to find section included one question modified from the reliable statistics on today’s elderly alcoholics at ASSIST-Lite version which asked about tobacco use district level in the northern Thailand [25]. This during the past three months. Each question study aimed to examine the prevalence of alcohol included the options “yes” or “no”. consumption and associated factors among older Part 4 included seven questions regarding the adults at community level to understand current heath related factors included perceptions of current situation for target health promotion policy health status, problem to dealing relationship, implementation among this vulnerable group. problem to dealing with conflicts, problem of pains, problem of sleep, problem of depressed, and MATERIALS AND METHODS problem of anxiety. An overall self-rated health This was a household cross sectional status question was asked as, “In general, how descriptive study. Data on current alcohol would you rate your health today?” The response consumption among Thai adults aged 50 years and choices included; 1) very good; 2) good; J Health Res vol.31 no.2 April 2017 http://www.jhealthres.org 101 Table 1 Distribution of alcohol consumption, respondents’ characteristics, current tobacco use, health related factors, social networks, and health service utilization (n=309) Characteristics Frequency % Current alcohol consumption Yes 74 23.9 No 235 76.1 Age group (years) 50 – 59 143 46.3 > 60 166 53.7 Median 60 (QD 5.5) Age range 50-95 Gender Male 124 40.1 Female 185 59.9 Current marital status Without spouse 96 31.3 With spouse 213 68.7 Education level Less than primary school 54 17.5 Primary school completed 178 57.6 Higher than primary school completed 77 24.9 Current tobacco use Yes 31 10.0 No 278 90.0 Perceptions of current health status Negative 86 27.8 Moderate 174 56.3 Positive 49 15.9 Problem to dealing with relationships Low 250 80.9 High 59 19.1 Problem to dealing with conflicts Low 258 83.5 High 51 16.5 Problem of pains Low 264 85.4 High 45 14.6 Problem of sleep Low 281 90.9 High 28 9.1 Problem of depressed Low 252 81.6 High 57 18.4 Problem of anxiety Low 281 90.9 High 28 9.1 Public meetings attended High frequency 100 32.4 Low frequency 209 67.6 Group meetings attended High frequency 93 30.1 Low frequency 216 69.9 Social contact High frequency 146 47.2 Low frequency 163 52.8 Modern medicine providers contact Low frequency 166 53.7 High frequency 143 46.3 Herbal medicine providers contact Low frequency 247 79.9 High frequency 62 20.1 Abbreviation: QD quartile deviation 3) moderate; 4) bad; and 5) very bad.