Australasian Journal on Ageing, Vol 25 No 2 June 2006, 97–100 97© 2006 COTA National Seniors Partnership

DOI: 10.1111/j.1741-6612.2006.00159.xBlackwell Publishing AsiaBrief ReportReasons for changing alcohol use

Reasons for changing alcohol use among older people in New Zealand

Nadim Khan, Tim J Wilkinson and Sally KeelingHealth Care of the Elderly, Christchurch School of Medicine and Health Sciences, Princess Margaret Hospital, Christchurch, New Zealand

Objective: To determine self-reported reasons for drinking alcohol and for changing alcohol use in older people.Methods: Descriptive cross-sectional study using semistructured questionnaire interviews of 141 randomly selected community-dwelling older people.Results: The 100 current drinkers said they consumed alcohol for social reasons, before and with meals and because alcohol helped them to relax: 45 had not changed their alcohol consumption over the past 12 months, nine had increased, 43 decreased and three did not know. Reasons for increasing were encouragement from friends, loneliness, as an alternative to smoking and enjoyment of drinking alcohol. Reasons for decreasing were mostly for health concerns or because of pressure from family or friends.Conclusions: Suggested strategies for influencing alcohol consumption in older people might include health promotion and education about potential negative health outcomes, in the context of ensuring appropriate social engagement in later life.

Key words: aged, alcohol deterrents, alcohol drinking, community surveys, health behaviour.

IntroductionThere is a gap between recognising a problem and knowingwhat to do about it. It is well known that excessive alcohol useis not confined to younger people. Our work [1,2] and thework of others [3] have shown that the reported prevalenceof current hazardous patterns of alcohol use by older peoplein New Zealand can range from 4% to 10%. It is also knownthat patterns of alcohol use can change over a lifetime: cross-sectional [4,5] and longitudinal [6,7] studies have shown theprevalence of problem drinking declines with age. The reasonsfor these changes are not very clear and are the focus of thispaper.

This is an important area to understand as: (i) alcohol is themost commonly used recreational drug in New Zealand [8];(ii) alcohol use is prevalent among older people [1,2]; (iii) thenumbers of older people in New Zealand, as in most othercountries, are increasing [9]; and (iv) older people experiencesome unique problems associated with drinking: older peopleare more vulnerable to the effects of alcohol [10], symptoms of

alcohol misuse can be mistaken for conditions related to ageingand alcohol can interact adversely with frequently usedmedications [11].

If we can understand the reasons why some older peoplechange their patterns of alcohol use, this may provide someinsights into interventions that may be more effective for olderpeople for whom reducing their alcohol intake might providea health benefit.

The aim of this study is to explore reasons given by older peoplefor drinking alcohol and for changing their alcohol use over time.

MethodsThis was a cross-sectional survey that drew on individuals’own descriptions of reasons for change in alcohol use overtime.

The study participants (n = 141) were all aged 65 years andolder and were part of a previously reported prevalence studyof alcohol use by older people in the community [1]. Partici-pants were randomly selected from the electoral roll inChristchurch, New Zealand. Inclusion and exclusion criteriahave been described previously [1].

Drinking status was categorised [12] as infrequent drinkers(who took less than 12 drinks in any 1 year); former drinkers(who took 12 or more drinks in 1 or more years previously, butless than 12 drinks in the past 12 months), and current drinkers(who consumed 12 or more drinks in the past year).

A list of possible reasons for using alcohol was developed intwo ways: (i) we conducted a pilot focus group interview withopen-ended topics among four elderly people aged 65 yearsand over; and then (ii) we compared these responses with apreviously developed questionnaire [13]. There was goodagreement between both sources of information so we used theexisting questionnaire [13], but we also recorded responses toopen-ended questions. Participants were asked to state reasonsfor using alcohol and for any change in alcohol use. Participantscould give more than one reason. Free text responses wererecorded, and then each participant was asked specificquestions from the questionnaire [13]. Changes over the last12 months only were recorded to minimise recall bias [14].

Each study participant was approached individually and thenature and purpose of the study was explained. Participantswere provided with an information sheet about the study andasked for their written consent in a prescribed form. An

Correspondence to: A/Professor Tim Wilkinson, Princess Margaret Hospital. Email: tim.wilkinson@chmeds.ac.nz

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interview was conducted once with each participant. Eachinterview lasted for approximately 30 minutes. The study receivedapproval from the Canterbury Ethics Committee, New Zealandand all participants gave written informed consent.

ResultsThere were 100 current drinkers, 18 infrequent drinkers,14 former drinkers and nine lifetime abstainers [12].

Reasons for current alcohol useIn answer to the open-ended questions, most of the 100 currentdrinkers said they consumed alcoholic drinks for socialreasons, with this differentiated further into social reasonsand enjoyment (n = 53), social reasons alone (n = 23), forsocialisation and relaxation purposes (n = 9), for socialisationand with food (n = 7). Small numbers said that they drankbecause they believed that alcohol was good for their health(n = 4) or that they drank out of habit (n = 3).

The 14 participants classified as former drinkers said theyused alcohol for social reasons (n = 11), socialisation andenjoyment (n = 2) and peer pressure (n = 1).

The reasons given by the 18 lifetime infrequent drinkers forusing alcohol were social reasons (n = 15), socialisation andenjoyment (n = 2) and peer pressure (n = 1).

The reasons the nine lifetime abstainers gave for never havingused alcohol were ‘never enjoyed’ (n = 4), ‘abstinence ofparents’ (n = 3), one stated ‘never enjoyed, financial reasonsand adverse effects of alcohol’ and the other stated ‘precipi-tates migraine and has an alcoholic family member’.

Table 1 shows responses to the questionnaire [13] options forusing alcohol from the current, former and lifetime infrequent

drinkers. This confirms the most commonly stated reasons tobe social or to accompany food.

Reasons for changes in alcohol useChanges in the patterns of alcohol use in the past 12 monthsamong the 100 current drinkers were recorded as follows: nochange in 45, reduced in 43, increased in nine and three wereunsure. Reasons for reducing alcohol use were given by 23 ofthe 43 people and were classified as:

• Health-related causes: personal health concerns (n = 13),advice from a doctor (n = 3) and concern about the effectsof alcohol (n = 4).

• Peer or family pressure: encouragement from friends(n = 3), family pressure (n = 2).

• Change in personal circumstances (n = 2).• Financial reasons (n = 4).• No longer liked alcohol (n = 2).

The 14 former drinkers were asked to describe any change intheir alcohol use during the time when they drank alcohol.Eight reported no change, whereas six said that theiralcohol use had further decreased, which could be furtherclassified as:

• Health-related causes: personal health concerns (n = 1) oradvice from a doctor (n = 1).

• Peer or family pressure: encouragement from friends(n = 2) or of peer pressure (n = 1).

• Change in personal circumstances (n = 1).• Financial reasons (n = 1).• No longer liked alcohol (n = 1).

Of the nine current drinkers who mentioned an increase inalcohol use, only three gave reasons: encouragement fromfriends, loneliness, an alternative to smoking or enjoyment ofdrinking alcohol.

Table 1: Reasons for alcohol consumption among current, former and lifetime infrequent drinkers of the community survey

Category Reasons Current (n = 100)

Former (n = 14)

Infrequent (n = 18)

Social Holidays and special occasions 74 (74%) 11 (78%) 12 (66%)Just to be social 76 (76%) 12 (85%) 14 (77%)Makes get-togethers more fun 54 (54%) 5 (35%) 3 (16%)

Food Before meals 60 (60%) 6 (42%) 2 (11%)With meals 53 (53%) 7 (50%) 4 (22%)After meals 8 (8%) 3 (21%) 3 (16%)

Mood changes Helps me relax 68 (68%) 9 (64%) 3 (16%)Sometimes helps me feel better 59 (59%) 7 (50%) 2 (11%)Makes me happier 36 (36%) 5 (35%) 0 (0%)

Health Helps me sleep 20 (20%) 1 (7%) 0 (0%)Doctor told me to drink 3 (3%) 0 (0%) 0 (0%)

Coping with personal situations Feels under pressure 6 (6%) 1 (7%) 0 (0%)Helps me forget my problems 4 (4%) 1 (7%) 0 (0%)Feels bored and has nothing to do 3 (3%) 1 (7%) 0 (0%)Helps me feel less lonely 3 (3%) 1 (7%) 0 (0%)Helps me feel more satisfied with myself 5 (5%) 2 (14%) 0 (0%)

Coping with social and interpersonal situations

Gives me more confidence 19 (19%) 4 (28%) 0 (0%)Makes me feel less shy 7 (7%) 1 (7%) 1 (5%)Makes me worry less about what other people think 5 (5%) 1 (7%) 0 (0%)Helps me get along better with others 10 (10%) 2 (14%) 0 (00%)

From: Christopherson et al. [13].Participants could give more than one reason.

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When the 18 lifetime infrequent drinkers were asked todescribe any change in their alcohol use during the time whenthey drank alcohol, 13 mentioned no change, four mentioneda reduction and one was not sure. Reasons given by the fourwho reduced their intake were: personal health concerns, dis-like for alcohol, concern about the effects of alcohol or havingan alcoholic father.

DiscussionThis study has explored reasons older people give for drinkingalcohol and for changing alcohol consumption with age. Thereasons given for drinking alcohol in our study were similar tothose found in an earlier New Zealand community-basedstudy among people aged 70 years and over [15]. That studyand the present one revealed that most of the participantsdrank alcohol for social reasons, before and with meals, witha small number drinking alcohol because of personal or socialcircumstances. In addition, our study has found that a signifi-cant number drank alcohol to help them relax, to feel better, tohelp sleep, to increase confidence or to help them to get alongwell with others.

The reasons for changing alcohol use with age have not pre-viously been explored. Our findings show that health-relatedcauses predominate, followed by peer or family pressure. Thissuggests that the role of the doctor and focusing on health mat-ters may have the greatest impact when it comes to counsellingolder people about alcohol use. Social or personal factors, suchas loneliness, can also have an impact, both in increasing anddecreasing alcohol intake.

The main strengths of this study are its community setting,data gathering by personal interview, and use of open-endedquestioning. The limitations of this study are the cross-sectional design and reliance on respondent recall. However,the focus of this study was primarily to understand perceptionsof important influences on changing alcohol intake and theseshould be less affected by these limitations.

A USA-based study [16] reported that depression, loneliness,and lack of social support were the most frequently citedantecedents to drinking for older alcoholics. An Italian study[17] found that men, those with poor cognitive function andincome dissatisfaction were significantly associated withalcohol problems. A large study based in the USA reportedthat, among lifelong abstainers, the most common reason fornot drinking was ‘dislike of alcohol’ (49%); other reasons were‘brought up not to’ (15%), ‘no need’ (15%), ‘religious/moralprohibitions’ (12%), ‘health problems’ (6%) and ‘other rea-sons’ (3%) [18]. The findings from these studies are similar toours, but none has looked at reasons for changing alcoholintake.

Health professionals are likely to encounter the manifestationsof excessive alcohol intake in older people. Alcohol use andmisuse among older people is associated with cognitive declineand is an independent risk factor for short-term mortality [19]

and functional decline [20]. The health practice and policyimplications from this study are firstly that health professionalsare likely to be well positioned to alter alcohol intake behav-iour. Health factors rate highly as demotivators for alcoholintake. Physician advice is associated with reduction in alcoholuse [21], so early recognition and referral by health-care pro-fessionals should support successful interventions. Secondly,social factors are strong drivers so attention to the livingcircumstances and social support of older people is also likelyto be important.

This study has shown that successful policies to influencealcohol intake are likely to need to take account of the socialand health circumstances of older people.

AcknowledgementsWe wish to express our gratitude to all the participants whoresponded to this survey. We are grateful for the financialsupport from the Alcohol Advisory Council of New Zealand(ALAC). The study received approval from the CanterburyEthics Committee, New Zealand.

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Key Points• Reasons given for changes in drinking patterns

were varied, but the influence of family or friendsand health concerns predominated.

• Social opportunities were of particular significancefor continuing alcohol consumption.

• Health promotion and education about negativehealth outcomes, in the context of appreciating thebenefits of social engagement in later life mayinfluence alcohol consumption in older people.

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