History of drinking problems diminishes the protective effects of within-guideline drinking on 18-year risk of dementia and CIND.

OBJECTIVE: To examine the moderating effect of older adults' history of drinking problems on the relationship between their baseline alcohol consumption and risk of dementia and cognitive impairment, no dementia (CIND) 18 years later. METHOD: A longitudinal Health and Retirement Study cohort (n = 4421) was analyzed to demonstrate how older adults' baseline membership in one of six drinking categories (non-drinker, within-guideline drinker, and outside-guideline drinker groups, divided to reflect absence or presence of a history of drinking problems) predicts dementia and CIND 18 years later. RESULTS: Among participants with no history of drinking problems, 13% of non-drinkers, 5% of within-guideline drinkers, and 9% of outside-guideline drinkers were classified as having dementia 18-years later. Among those with a history of drinking problems, 14% of non-drinkers, 9% of within-guideline drinkers, and 7% of outside-guideline drinkers were classified with dementia. With Non-Drinker, No HDP as reference category, being a baseline within-guideline drinker with no history of drinking problems reduced the likelihood of dementia 18 years later by 45%, independent of baseline demographic and health characteristics; being a baseline within-guideline drinker with a history of drinking problems reduced the likelihood by only 13% (n.s.). Similar patterns obtained for the prediction of CIND. CONCLUSIONS: For older adults, consuming alcohol at levels within validated guidelines for low-risk drinking may offer moderate long-term protection from dementia and CIND, but this effect is diminished by having a history of drinking problems. Efforts to predict and prevent dementia and CIND should focus on older adults' history of drinking problems in addition to how much alcohol they consume.

Mental health disorder, pain, and pain treatment among long-term care residents: Evidence from the Minimum Data Set 3.0.

Objective: This study evaluated: (a) associations between long-term care residents' mental health disorder diagnoses and their pain self-reports and pain treatments, and (b) the extent to which communication, cognitive, and physical functioning problems help explain disparities in the pain and pain treatments of long-term care residents with and without mental health disorders. Method: Minimum Data Set 3.0 records of 8,300 residents of Department of Veterans Affairs Community Living Centers were used to determine statistically unadjusted and adjusted cross-sectional associations between residents' mental health diagnoses and their pain and pain treatments. Results: Residents diagnosed with dementia and serious mental illness (SMI) were less likely, and those diagnosed with depressive disorder, post-traumatic stress disorder (PTSD), and substance use disorder (SUD) were more likely, to report recent, severe, and debilitating pain. Among residents affirming recent pain, those with dementia or SMI diagnoses were twice as likely to obtain no treatment for their pain and significantly less likely to receive as-needed pain medication and non-pharmacological pain treatments than were other residents. Those with either depressive disorder or PTSD were more likely, and those with SUD less likely, to obtain scheduled pain medication. In general, these associations remained even after statistically adjusting for residents' demographic characteristics, other mental health disorder diagnoses, and functioning. Conclusion: Long-term care residents with mental health disorders experience disparities in pain and pain treatment that are not well-explained by their functioning deficits. They may benefit from more frequent, thorough pain assessments and from more varied and closely tailored pain treatment approaches.

Drinking Level Versus Drinking Pattern and Cigarette Smoking Among Older Adults.

BACKGROUND: There is a lack of research on the role of alcohol consumption in cigarette smoking among older adults, and the few studies on alcohol use and smoking with older adults have failed to distinguish between average level and pattern of drinking as predictors of smoking. The main purpose of this study was to examine the independent contributions of average level versus pattern of drinking as predictors of cigarette smoking among older adults. A subsidiary purpose was to examine the link between continued smoking and mortality among older smokers. METHODS: We investigated average level and pattern of drinking as predictors of current smoking among 1,151 older adults at baseline and of continued smoking and mortality among the subset of 276 baseline smokers tracked across 20 years. We used multiple linear and logistic regression analyses and, to test mediation, bias-corrected bootstrap confidence intervals. RESULTS: A high level of average drinking and a pattern of episodic heavy drinking were concurrently associated with smoking at baseline. However, only episodic heavy drinking was prospectively linked to continued smoking among baseline smokers. Continued smoking among baseline smokers increased the odds of 20-year mortality and provided an indirect pathway through which heavy episodic drinking related to mortality. CONCLUSIONS: Smokers who misuse alcohol are a challenging population for smoking cessation efforts. Older adults who concurrently misuse alcohol and smoke cigarettes provide a unique target for public health interventions.

Episodic heavy drinking and 20-year total mortality among late-life moderate drinkers.

BACKGROUND: Analyses of moderate drinking have focused overwhelmingly on average consumption, which masks diverse underlying drinking patterns. This study examined the association between episodic heavy drinking and total mortality among moderate-drinking older adults. METHODS: At baseline, the sample was comprised of 446 adults aged 55 to 65; 74 moderate drinkers who engaged in episodic heavy drinking and 372 regular moderate drinkers. The database at baseline also included a broad set of sociodemographic, behavioral, and health status covariates. Death across a 20-year follow-up period was confirmed primarily by death certificate. RESULTS: In multiple logistic regression analyses, after adjusting for all covariates, as well as overall alcohol consumption, moderate drinkers who engaged in episodic heavy drinking had more than 2 times higher odds of 20-year mortality in comparison with regular moderate drinkers. CONCLUSIONS: Among older moderate drinkers, those who engage in episodic heavy drinking show significantly increased total mortality risk compared to regular moderate drinkers. Episodic heavy drinking-even when average consumption remains moderate-is a significant public health concern.

Painful medical conditions and alcohol use: a prospective study among older adults.

OBJECTIVE: To determine associations between older adults' baseline painful medical conditions and their 10-year drinking behavior, and whether personal and life context characteristics moderate these associations. METHODS: At baseline, then, 1, 4, and 10 years later, late-middle-aged community residents (M = 61 years; N = 1,291) were surveyed regarding their painful medical conditions, use of alcohol, and personal and life context characteristics. Latent growth modeling was used to determine concurrent and prospective relationships between painful medical conditions and 10-year drinking behavior, and moderating effects of personal and life context characteristics on these relationships. RESULTS: At baseline, individuals reporting more numerous painful medical conditions consumed alcohol less frequently, but had more frequent drinking problems, than did individuals with fewer such conditions. Being female and having more interpersonal social resources strengthened the association between painful medical conditions and less ethanol consumed. For men more so than women, more numerous painful medical conditions were associated with more frequent drinking problems. Baseline painful medical conditions alone had no prospective effect on 10-year change in drinking behavior, but being older and having more interpersonal social resources made it more likely that baseline painful medical conditions would predict decline over time in frequency of alcohol consumption and drinking problems. CONCLUSIONS: Late-middle-aged individuals who have more numerous painful medical conditions reduce alcohol consumption but nonetheless remain at risk for more frequent drinking problems. Gender, age, and interpersonal social resources moderate the influence of painful medical conditions on late-life alcohol use. These results imply that older individuals with pain are at little immediate or long-term risk for increased alcohol consumption, but clinicians should remain alert to drinking problems among their older pain patients, especially men.

Social and financial resources and high-risk alcohol consumption among older adults.

BACKGROUND: This study examined long-term mutual predictive associations between social and financial resources and high-risk alcohol consumption in later life. METHOD: A sample of 55- to 65-year-old older adults (n = 719) was surveyed at baseline and 10 years and 20 years later. At each contact point, participants completed an inventory that assessed social and financial resources and alcohol consumption. RESULTS: Over the 20-year interval, there was evidence of both social causation and social selection processes in relation to high-risk alcohol consumption. In support of a social causation perspective, higher levels of some social resources, such as participation in social activities, friends' approval of drinking, quality of relationship with spouse, and financial resources, were associated with a subsequent increased likelihood of high-risk alcohol consumption. Conversely, indicating the presence of social selection, high-risk alcohol consumption was associated with subsequent higher levels of friends' approval of drinking and quality of the spousal relationship, but lower quality of relationships with extended family members. CONCLUSIONS: These findings reflect mutual influence processes in which older adults' social resources and high-risk alcohol consumption can alter each other. Older adults may benefit from information about how social factors can affect their drinking habits; accordingly, information about social causation effects could be used to guide effective prevention and intervention efforts aimed at reducing the risk that late-life social factors may amplify their excessive alcohol consumption.

Late-life alcohol consumption and 20-year mortality.

BACKGROUND: Growing epidemiological evidence indicates that moderate alcohol consumption is associated with reduced total mortality among middle-aged and older adults. However, the salutary effect of moderate drinking may be overestimated owing to confounding factors. Abstainers may include former problem drinkers with existing health problems and may be atypical compared to drinkers in terms of sociodemographic and social-behavioral factors. The purpose of this study was to examine the association between alcohol consumption and all-cause mortality over 20 years among 1,824 older adults, controlling for a wide range of potential confounding factors associated with abstention. METHODS: The sample at baseline included 1,824 individuals between the ages of 55 and 65. The database at baseline included information on daily alcohol consumption, sociodemographic factors, former problem drinking status, health factors, and social-behavioral factors. Abstention was defined as abstaining from alcohol at baseline. Death across a 20-year follow-up period was confirmed primarily by death certificate. RESULTS: Controlling only for age and gender, compared to moderate drinkers, abstainers had a more than 2 times increased mortality risk, heavy drinkers had 70% increased risk, and light drinkers had 23% increased risk. A model controlling for former problem drinking status, existing health problems, and key sociodemographic and social-behavioral factors, as well as for age and gender, substantially reduced the mortality effect for abstainers compared to moderate drinkers. However, even after adjusting for all covariates, abstainers and heavy drinkers continued to show increased mortality risks of 51 and 45%, respectively, compared to moderate drinkers. CONCLUSIONS: Findings are consistent with an interpretation that the survival effect for moderate drinking compared to abstention among older adults reflects 2 processes. First, the effect of confounding factors associated with alcohol abstention is considerable. However, even after taking account of traditional and nontraditional covariates, moderate alcohol consumption continued to show a beneficial effect in predicting mortality risk.

Older adults' health and late-life drinking patterns: a 20-year perspective.

OBJECTIVES: This study focused on the associations between older adults' health-related problems and their late-life alcohol consumption and drinking problems. METHODS: A sample of 719 late-middle-aged community residents (55-65 years old at baseline) participated in a survey of health and alcohol consumption and this survey was followed 10 years and 20 years later. RESULTS: Health-related problems increased and alcohol consumption and drinking problems declined over the 20-year interval. Medical conditions, depressive symptoms, medication use, and acute health events were associated with a higher likelihood of abstinence; acute health events were also associated with less alcohol consumption. In contrast, reliance on alcohol to reduce pain was linked to more alcohol consumption. Moreover, an individual's overall health burden and reliance on alcohol to reduce pain were associated with more drinking problems. Reliance on alcohol to reduce pain potentiated the association between health burden, alcohol consumption and drinking problems. CONCLUSION: Older adults who have more health problems and rely on alcohol to manage pain are at elevated risk for drinking problems. Health care providers should target high-risk older adults, such as those who drink to reduce pain, for screening and brief interventions to help them identify new ways to cope with pain and curtail their drinking.

Implementing a cornerstone of culture change: Consistent staff assignment in VHA community living centers.

In 2011, the Veterans Health Administration (VHA) began implementing consistent staff assignment in its nursing homes (called Community Living Centers or CLCs). Consistent assignment, a cornerstone of culture change, minimizes the number of staff who provide a resident's care. The present research assessed the level and stability of consistent assignment in units within VHA CLCs and identified unit characteristics related to implementation of this staff assignment model. Schedulers in 185 of 335 organizational units that make up VHA CLCs completed a Staffing Practices Survey. For the month prior to the survey, 53% of CLC units had full implementation of consistent assignment. Tracked back over time, 37% of CLC units had stable high consistent assignment, 29% had stable low consistent assignment, and 34% were variable. Units with stable high consistent assignment were most likely to use care teams with stable membership and to obtain staff input for care assignments. Schedulers in these units reported more positive experiences with consistent staff assignment and better unit functioning in terms of staff absences, complaints about workload fairness, and resolution of scheduling problems. Units with stable low and variable consistent assignment were similar in most of these respects; however, units with variable consistent assignment made greater use of stable care teams and were less likely to change assignments at a staff member's request. Overall, consistent assignment implementation was not related to unit size, nursing hours per resident day, or specialty focus. Findings can help guide consistent staff assignment implementation in VHA and community nursing homes. (PsycINFO Database Record

Late-Life Drinking Problems: The Predictive Roles of Drinking Level vs. Drinking Pattern.

OBJECTIVE: Research on late-middle-aged and older adults has focused primarily on average level of alcohol consumption, overlooking variability in underlying drinking patterns. The purpose of the present study was to examine the independent contributions of an episodic heavy pattern of drinking versus a high average level of drinking as prospective predictors of drinking problems. METHOD: The sample comprised 1,107 adults ages 55-65 years at baseline. Alcohol consumption was assessed at baseline, and drinking problems were indexed across 20 years. We used prospective negative binomial regression analyses controlling for baseline drinking problems, as well as for demographic and health factors, to predict the number of drinking problems at each of four follow-up waves (1, 4, 10, and 20 years). RESULTS: Across waves where the effects were significant, a high average level of drinking (coefficients of 1.56, 95% CI [1.24, 1.95]; 1.48, 95% CI [1.11, 1.98]; and 1.85, 95% CI [1.23, 2.79] at 1, 10, and 20 years) and an episodic heavy pattern of drinking (coefficients of 1.61, 95% CI [1.30, 1.99]; 1.61, 95% CI [1.28, 2.03]; and 1.43, 95% CI [1.08, 1.90] at 1, 4, and 10 years) each independently increased the number of drinking problems by more than 50%. CONCLUSIONS: Information based only on average consumption underestimates the risk of drinking problems among older adults. Both a high average level of drinking and an episodic heavy pattern of drinking pose prospective risks of later drinking problems among older adults.

Predictors of untreated remission from late-life drinking problems.

OBJECTIVE: Studies of mixed-aged samples have suggested that a majority of problem drinkers achieve remission "naturally", without formal treatment. We sought to describe the life history predictors of untreated remission among older adults. METHOD: We compared 330 older untreated remitters to 120 older treated remitters and to 130 untreated nonremitters. RESULTS: A majority (73%) of remitted, older problem drinkers attained remission without any formal treatment for drinking problems. Compared with treated remitters, late-life untreated remitters were more likely to be women and had completed more schooling, reached their peak alcohol consumption and ceased development of new drinking problems earlier, had much less severe drinking and depression histories, and were less likely to have received any advice to reduce consumption. Compared with untreated nonremitters, untreated remitters were more likely to be women, reached their peak alcohol consumption and stopped developing new drinking problems almost a decade earlier, had somewhat less severe drinking histories, were less likely to have been advised to reduce consumption, and were more likely to have reacted to late-life health problems by reducing their alcohol consumption. CONCLUSIONS: Many late-life problem drinkers with milder drinking problems achieve remission without treatment or advice to reduce consumption. However, a notable percentage of untreated older individuals who have more severe drinking problems could benefit from public health efforts to aid detection of late-life drinking problems and interventions aimed at reducing alcohol consumption. Results suggest that such interventions should highlight the negative health consequences of excessive late-life drinking.

Long-Term Patterns and Predictors of Successful Stressor Resolution in Later Life.

At 1 year, 4 years, and 10 years after baseline, late-middle-aged adults reported whether they had successfully resolved their most important stressor of the past year. Compared to individuals who never resolved focal stressors over the 10-year interval, those who always did consistently showed less negative stressor appraisal, less reliance on avoidance coping, and less use of exploratory relative to directed coping responses, independent of type and severity of focal stressor. Less use of exploratory relative to directed coping and having more social resources, fewer health problems, and fewer depressive symptoms at baseline predicted more stressor resolution over the next 10 years. These predictors are promising foci for prospective efforts to optimize ways in which aging adults manage late-life stressors.

Alcohol Use Predicts 10-Year Depressive Symptom Trajectories in the Health and Retirement Study.

OBJECTIVE: To determine effects of late-middle-aged adults' baseline drinking behavior on their subsequent 10-year depressive symptom trajectories. METHOD: Health and Retirement Study participants (N = 7,939) were assessed on baseline demographic, health, and drinking characteristics, and biennially assessed for the next 10 years on their depressive symptoms. RESULTS: Growth mixture modeling generated four classes of depressive symptom trajectories: Consistently low (72%), consistently elevated (6%), increasing (12%), and decreasing (10%). Baseline abstinence from alcohol, possibly enforced by poorer health and a history of drinking problems, and heavier drinking, "binge" drinking, and having a history of drinking problems, raised risk of membership in the "consistently elevated" class. Abstinence by participants without history of drinking problems-and light, moderate, and heavier drinking-protected against membership in the "increasing" class. Abstinence by participants without history of drinking problems elevated-and moderate drinking reduced-likelihood of membership in the "decreasing" class. DISCUSSION: Late-middle-aged adults' alcohol use is associated with the subsequent long-term course of their depressive symptoms.

Pain and use of alcohol to manage pain: prevalence and 3-year outcomes among older problem and non-problem drinkers.

AIMS: Most older adults report having recently experienced pain, and many older adults have late-life drinking problems. However, to our knowledge, the intersection of pain and alcohol misuse by older adults has not been studied. This research focuses on the implications of pain for older individuals who have problems with alcohol. DESIGN: Longitudinal survey. SETTING, PARTICIPANTS AND MEASUREMENT: Older community-residing adults (n = 401) were classified as problem and non-problem drinkers. At baseline and 3 years later they were asked to provide information about their pain, use of alcohol to manage pain, drinking behavior, chronic health problems and recent serious injury. FINDINGS: At baseline, older problem drinkers reported more severe pain, more disruption of daily activities due to pain and more frequent use of alcohol to manage pain than did older non-problem drinkers. More pain was associated with more use of alcohol to manage pain; this relationship was stronger among older adults with drinking problems than among those without drinking problems. Among older men, more baseline drinking problems interacted with use of alcohol to manage pain to predict more health problems and serious injury 3 years later. Among older women, more baseline drinking problems interacted with use of alcohol to manage pain to predict more drinking problems 3 years later. CONCLUSIONS: The results highlight the importance of monitoring the drinking behavior of older patients who present with pain complaints, especially patients who have pre-existing problems with alcohol.

Stress generation, avoidance coping, and depressive symptoms: a 10-year model.

This study examined (a) the role of avoidance coping in prospectively generating both chronic and acute life stressors and (b) the stress-generating role of avoidance coping as a prospective link to future depressive symptoms. Participants were 1,211 late-middle-aged individuals (500 women and 711 men) assessed 3 times over a 10-year period. As predicted, baseline avoidance coping was prospectively associated with both more chronic and more acute life stressors 4 years later. Furthermore, as predicted, these intervening life stressors linked baseline avoidance coping and depressive symptoms 10 years later, controlling for the influence of initial depressive symptoms. These findings broaden knowledge about the stress-generation process and elucidate a key mechanism through which avoidance coping is linked to depressive symptoms.

The interplay between life stressors and depressive symptoms among older adults.

This study examined mutual predictive associations between life stressors and depressive symptoms in later life. A sample of late-middle-aged and older adults (N = 1,291) was surveyed at baseline and 1 year, 4 years, and 10 years later. At each contact point, participants completed an inventory that assessed chronic and acute life stressors and depressive symptoms. Over the 10-year interval, there was evidence of both social causation and social selection processes: More life stressors were associated with subsequent increases in depressive symptoms (social causation), and more depressive symptoms were associated with subsequent increases in stressors (social selection or stress generation). These findings reflect a mutual influence process in which life stressors and depressive symptoms can alter each other.

Sequencing the lifetime onset of alcohol-related symptoms in older adults: is there evidence of disease progression?

OBJECTIVE: The purpose of this study was to evaluate evidence of orderly symptom progression in alcohol-use disorders (disease-progression model). METHOD: A sample of community-residing older problem drinkers provided information about their life history of drinking, including the age at which they had experienced alcohol-related symptoms that correspond to criteria for alcohol abuse and dependence. Symptom sets and possible sequences were formulated separately for women and men, based on the average number of years from drinking initiation to symptom onset and on symptom prevalence. We assessed how well the ordering of symptoms experienced by individual respondents matched the sequences derived with these group-level measures; we also assessed whether individuals progress from alcohol abuse to dependence as is implied in some conceptualizations of alcohol-use disorders. RESULTS: Half or more of these older adults experienced symptom onset in an order that was inconsistent with the possible symptom sequences derived from group-level analysis (e.g., reversals from the expected order or concurrent onset of symptoms expected to occur sequentially). Similarly, alcohol abuse did not appear to be a precursor to the development of alcohol dependence in individual patterns of symptom onset. CONCLUSIONS: Although group-level results based on the number of years from drinking initiation to symptom onset or on symptom prevalence may seem to point to orderly progression in the development of alcohol-related symptoms, these group-level results do not capture individual experiences very well. In this community-residing sample of problem drinkers, most of whom had never sought treatment, there was marked variability in the course of symptom development, which raises questions about the utility of a disease-progression model.

Drinking Level, Drinking Pattern, and Twenty-Year Total Mortality Among Late-Life Drinkers.

OBJECTIVE: Research on moderate drinking has focused on the average level of drinking. Recently, however, investigators have begun to consider the role of the pattern of drinking, particularly heavy episodic drinking, in mortality. The present study examined the combined roles of average drinking level (moderate vs. high) and drinking pattern (regular vs. heavy episodic) in 20-year total mortality among late-life drinkers. METHOD: The sample comprised 1,121 adults ages 55-65 years. Alcohol consumption was assessed at baseline, and total mortality was indexed across 20 years. We used multiple logistic regression analyses controlling for a broad set of sociodemographic, behavioral, and health status covariates. RESULTS: Among individuals whose high level of drinking placed them at risk, a heavy episodic drinking pattern did not increase mortality odds compared with a regular drinking pattern. Conversely, among individuals who engage in a moderate level of drinking, prior findings showed that a heavy episodic drinking pattern did increase mortality risk compared with a regular drinking pattern. Correspondingly, a high compared with a moderate drinking level increased mortality risk among individuals maintaining a regular drinking pattern, but not among individuals engaging in a heavy episodic drinking pattern, whose pattern of consumption had already placed them at risk. CONCLUSIONS: Findings highlight that low-risk drinking requires that older adults drink low to moderate average levels of alcohol and avoid heavy episodic drinking. Heavy episodic drinking is frequent among late-middle-aged and older adults and needs to be addressed along with average consumption in understanding the health risks of late-life drinkers.

Diagnostic accuracy of brief PTSD screening instruments in military veterans.

Post-traumatic stress disorder (PTSD) is prevalent but is under-detected and under-treated, despite available efficacious treatments. To improve detection rates, screening instruments such as the PTSD Checklist (PCL) and the Primary Care-PTSD (PC-PTSD) screen have been widely used. However, validation of these screening instruments among patients seeking treatment in substance use disorder (SUD) specialty treatment clinics and general mental health (MH) treatment clinics is limited. Therefore, this study assessed the area under the ROC curve (AUC), sensitivity, specificity, efficiency, and positive and negative predictive values of the PCL, PC-PTSD, and five abbreviated versions of the PCL in detecting PTSD among samples of patients seeking treatment in SUD specialty treatment (n=158) and general MH treatment settings (n=242). A computer-assisted structured diagnostic interview (C-DIS-IV) was used to ascertain patient DSM-IV PTSD diagnostic status. Based on the C-DIS-IV, prevalence of PTSD was found to be 36.7 and 52.9% in the SUD and MH samples, respectively. The PCL, PC-PTSD, and five abbreviated versions of the PCL were found to have adequate psychometric properties for screening patients in SUD (AUC ranged from 0.80 to 0.86) and MH (AUC ranged from 0.77 to 0.80) outpatient treatment settings.

Wine consumption and 20-year mortality among late-life moderate drinkers.

OBJECTIVE: This study examined level of wine consumption and total mortality among 802 older adults ages 55-65 at baseline, controlling for key sociodemographic, behavioral, and health status factors. Despite a growing consensus that moderate alcohol consumption is associated with reduced total mortality, whether wine consumption provides an additional, unique protective effect is unresolved. METHOD: Participants were categorized in three subsamples: abstainers, high-wine-consumption moderate drinkers, and low-wine-consumption moderate drinkers. Alcohol consumption, sociodemographic factors, health behavior, and health problems were assessed at baseline; total mortality was indexed across an ensuing 20-year period. RESULTS: After adjusting for all covariates, both high-wine-consumption and low-wine-consumption moderate drinkers showed reduced mortality risks compared with abstainers. Further, compared with moderate drinkers for whom a high proportion of ethanol came from wine, those for whom a low proportion of ethanol came from wine were older, were more likely to be male, reported more health problems, were more likely to be tobacco smokers, scored lower on socioeconomic status, and (statistical trend) reported engaging in less physical activity. Controlling only for overall ethanol consumption, compared with moderate drinkers for whom a high proportion of ethanol came from wine, those for whom a low proportion of ethanol came from wine showed a substantially increased 20-year mortality risk of 85%. However, after controlling for all covariates, the initial mortality difference associated with wine consumption was no longer significant. CONCLUSIONS: Among older adults who are moderate drinkers, the apparent unique effects of wine on longevity may be explained by confounding factors correlated with wine consumption.