Alcohol abuse among aging adults is thought to be one of the fastest growing health concerns in the United States. To manage this problem, a stepped-care approach is recommended. This approach consists of brief interventions and, if necessary, a more extensive treatment program to help individuals self-manage their drinking habits. Brief interventions fall within the harm reduction philosophy and normally consist of one to five short sessions. In contrast, The Gerontology Alcohol Project (GAP) offers a more comprehensive treatment protocol for individuals who require enhanced self-management guidelines. Both treatment strategies are supported by research conducted with older alcohol abusers.

This study focused on the prospective associations between older adults' health-related problems and their late-life alcohol consumption and drinking problems. A sample of 1,291 late-middle-aged community residents (55-65 years old at baseline) participated in a survey of health and alcohol consumption, and was followed one year, four years, and 10 years later. Health-related problems increased and alcohol consumption and drinking problems declined over the 10-year interval. Medical conditions, physical symptoms, medication use, and acute health events predicted a higher likelihood of abstinence and less frequent and lower alcohol consumption. However, overall health burden predicted more subsequent drinking problems, even after controlling for alcohol consumption and a history of heavy drinking and increased drinking in response to stressors. Among older adults, increased health problems predict reduced alcohol consumption but more drinking problems. Older adults with several health problems who consume more alcohol are at elevated risk for drinking problems and should be targeted for brief interventions to help them curtail their drinking.

With global trends in population aging, many nations are developing and implementing healthy aging policies to promote quality as well as years of healthy life. To broaden the evidence base for such policy development, a review of the literature was conducted to summarize the existing evidence regarding the behavioral determinants of healthy aging. Such research is needed so that the efficacy of modes of intervention can be better understood. The outcome of "healthy" or "successful" aging was selected for this review since this nomenclature dominates the literature describing a global measure of multidimensional functioning at the positive end of the health continuum in older age. Studies published between 1985 and 2003 that reported statistical associations between baseline determinants and healthy aging outcome were identified from a systematic search of medical, psychological, sociological, and gerontological databases. Eight studies satisfied the search criteria. Modifiable risk factors among the behavioral determinants included smoking status, physical activity level, body mass index, diet, alcohol use, and health practices. On the basis of these findings, effective healthy aging policies need to enhance opportunities across the life span for modification of lifestyle risk factors. Efforts to standardize concepts and terminology will facilitate further research activity in this important area.

This study investigated the relationship between alcohol consumption and cognitive performance in two culturally diverse community-based populations. METHODS. A cross-sectional analysis was used including Japanese Americans (n = 1,836) and Caucasians (n = 2,581) aged 65 and older. Cognitive performance was measured using the Cognitive Abilities Screening Instrument (CASI) (0 to 100 point scale) and reaction time. RESULTS. Multivariate analysis revealed significant cultural and gender differences with cognitive performance. Compared to abstainers, Caucasian drinkers scored higher than Japanese American drinkers on the CASI (adjusted means = 93.4 versus 91.6). In contrast, Japanese American drinkers scored faster than Caucasian drinkers on choice reaction time (adjusted means = 505 versus 579 milliseconds). DISCUSSION. Results showed that current drinking was associated with better cognition in both the Caucasian and Japanese American groups. Longitudinal studies are needed to support the possible protective effects of alcohol on cognition and explore whether culture may modify this apparent benefit.

BACKGROUND: Epidemiological studies of traits such as alcohol dependence and depression have often found lifetime rates in younger individuals exceeding those found in older individuals. This suggests additional influences of birth cohort or period effects so that individuals in later-born cohorts have an increased lifetime risk. METHODS: Data from the Collaborative Study on the Genetics of Alcoholism were used to investigate secular trends for alcoholism and related conditions and to examine risk predictors while taking the cohort effect into account. We used data on 4099 interviewed parents and siblings of alcohol-dependent subjects and 1054 members of control families. We used survival analysis techniques and the Cox proportional hazards regression model to estimate the relative risk for demographic covariates. We used the relative sample to predict risk in the sibling of the proband and family history information to determine whether there was a bias when deceased individuals were excluded from analysis. RESULTS: In the control sample, we observed a 1.8% lifetime rate of DSM-III-R alcohol dependence in women born before 1940, as contrasted to a 13% rate in women born after 1960, and a 15% lifetime rate in men born before 1940, contrasted with a 28% rate in men born after 1960. As expected, lifetime rates in relatives were increased when compared with controls. Highly significant risk ratios (RR) were observed for gender (RR, 2.3), cohort of birth (RR, 1.5 over a decade), daily smoking (RR, 2.0), heavy smoking (RR, 3.0), and comorbid diagnoses of antisocial personality (RR, 2.2) and depression (RR, 1.6). Analysis of the family history data indicated higher rates of alcohol dependence in relatives who were deceased compared to those who were living. CONCLUSIONS: Marked cohort differences were observed and may reflect real changes over time, or artifacts of memory recall, differential mortality, or public awareness. The analysis of all relatives (living or deceased) indicates that associated mortality may, in part, explain the secular trends seen when analyses are restricted to living, personally interviewed individuals.

BACKGROUND: Research has shown that heavy alcohol use has a detrimental effect on retrospective memory. Less is known about the effect of alcohol on everyday memory. METHODS: This study examined self-ratings of two aspects of memory performance: prospective memory (for example, forgetting to pass on a message) and everyday memory (measured by cognitive failures, such as telling someone a joke that you have told them before). To ensure anonymity and expand on the numbers of participants used in previous studies, data were collected by using the Internet. Data from 763 participants remained after data screening. RESULTS: After controlling for other drug and strategy use, there was clear evidence that differential use of alcohol was associated with impairments in the long-term aspect of prospective memory and with an increased number of cognitive failures. CONCLUSIONS: These results support and extend the findings of previous research: our findings are consistent with the idea that heavy use of alcohol does have a significant and negative effect on everyday cognitive performance. Possible causes of these impairments are discussed.

BACKGROUND: This study examined gustatory measures (intensity and hedonic values of salt and citric acid solutions) that have been reported to differentiate nonalcoholics who are at risk of alcoholism by virtue of having an alcoholic father (PHP) from those with no such paternal history (PHN). The study tested the hypothesis that PHPs perceive salty and sour solutions to be more intense and less pleasurable than do PHNs. METHODS: A total of 112 nonalcoholic subjects (44.7% male and 40.2% PHP) provided intensity and pleasantness ratings for a series of salty and sour solutions in varying concentrations. RESULTS: PHP subjects rated salty solutions as more unpleasant than PHN subjects. PHP subjects also showed higher mean sour intensity ratings and less preference for sour solutions than PHN subjects. CONCLUSIONS: This study replicates and extends prior findings of salty and sour taste differences as a function of paternal history of alcoholism. Further research is needed to replicate these findings in other populations and to examine their implications for the transmission of alcoholism risk.

BACKGROUND: Research has demonstrated that alcohol-related aggression is modulated by anger-based personality traits. However, it is unclear how anger, as a concomitant of aggression, is affected by an interaction among these variables. The present study evaluated the effects of alcohol, anger-based traits, and physical provocation on anger. METHODS: Participants were 136 male social drinkers who completed measures designed to assess trait anger and anger expression styles and were assigned to an alcohol or no-alcohol control beverage group. Participants engaged in a competitive reaction time task in which electric shocks were received from a fictitious opponent. Participants' experience of anger was assessed unobtrusively via the Facial Action Coding System. RESULTS: Intoxicated participants displayed more facial expressions of anger than sober participants. Interactive effects between anger expression styles and beverage group also were detected in that, among intoxicated participants, a positive relationship between facial expressions of anger and the tendency to express anger outwardly was found after high, but not low, provocation. This relationship was not observed at either provocation level in the no-alcohol control group. Similarly, whereas participants' tendency to control anger resulted in fewer facial expressions of anger by intoxicated participants, no such relationship was found among sober participants. CONCLUSIONS: Findings suggest that alcohol intoxication facilitates the experience of anger after provocation and enhances the relationship between state anger and behavioral tendencies to control anger expression.

BACKGROUND Chronic myopathy due to excessive ethanol intake is one of the most frequent causes of acquired skeletal myopathy in developed countries. Its pathogenesis is multi-factorial, only partially clarified, and antioxidant imbalance has been suggested to influence its development, being a type II glucolytic, fast-twitch fiber subset more sensitive to this effect. METHODS: We assessed superoxide dismutase, glutathione peroxidase, and glutathione reductase enzyme activities as well as the total antioxidant status capacity in muscle samples obtained from 41 chronic alcoholic males and 12 age-matched controls. Alcoholic skeletal myopathy was defined according to standard histologic criteria. We evaluated the influence of ethanol consumption, caloric and protein nutritional status, and the presence of skeletal myopathy with the tissue activities of these antioxidant enzymes. RESULTS: Chronic alcoholics showed a 16% reduction in glutathione peroxidase and a 13% increase of superoxide dismutase in the skeletal muscle, compared with controls (p < 0.05, both). Muscle antioxidant changes in chronic alcoholics were not related to the presence of skeletal myopathy, parameters of alcohol consumption, or conventional nutritional parameters. CONCLUSIONS: Antioxidant muscle enzyme activities are partially disturbed in chronic alcoholism, although not related to the presence of myopathy, amount of ethanol consumed, or the nutritional status of the patients. Further studies should assess other aspects not included in the present study such as muscle site-specific changes in antioxidant status/oxidative damage, specific fiber-type sensitivity to alcohol, and type and quantity of antioxidant content of the diet or in the alcohol beverages.

BACKGROUND: The aim of this study was to better evaluate the role of alcohol drinking in fatalities linked to road traffic accidents. METHODS: The data of accidents were collected by a French official agency from police records, including many variables, among which was a blood alcohol test. They were analyzed in a descriptive way and toward a logistic regression. This exhaustive database comprised all of the 500,961 accidents with casualties that involved less than three vehicles (28,506 fatal accidents) recorded in France during a 52 month period (September 1995 to December 1999). The results of the alcohol tests were known in 78.7 of the drivers. RESULTS: The blood alcohol concentration was over the legal limit (0.50 g/L in France) in 9.8% of the accidents with casualties overall. Considering only fatal accidents, the rate of positive alcohol test in drivers was approximately 31.5%. This rate varied depending on the period and the type of accident, raising up to 71.2% in single-vehicle accidents (loss of control) at night during the weekend. The percentage of positive alcohol tests also dramatically increased following the number of fatalities per accident (87.5% in single-vehicle accidents during weekend nights involving three or more killed). The logistic regression in single-vehicle accident shows that the higher odds ratios concern the positive blood alcohol test (OR = 4.19), clearly overwhelming the other precipitating factors of accidents (age of driver, meteorological conditions, time of day, and other factors). CONCLUSIONS: Drinking alcohol before driving is a well known factor of accidents. We clearly demonstrate here that it is the main factor leading to deaths linked to road traffic accidents in France. The results are strengthened, and some analyses are allowed, by the exceptional features of our database. The authors emphasize the need for prevention measures.

Epidemiological studies have shown a favourable effect of moderate alcohol consumption with regard to atherosclerotic disorders. In addition to alcohol, wine contains a large number of other components including polyphenols. These polyphenols mainly originate from the skins and seeds of grapes and, because of differences in vinification, their variety and concentration is higher in red wine than in white wine. In vitro and ex vivo studies have shown that some of these polyphenols are able to slow down LDL-cholesterol oxidation, stimulate NO production, influence prostaglandin synthesis and inhibit platelet aggregation. However, little is known about their resorption, bioavailability and effectiveness in vivo. Since data from intervention studies with wine polyphenols are also lacking, no statement can yet be made about any clinically relevant effect of these components, in either red or white wine, in terms of cardiovascular diseases.

BACKGROUND: Alcohol consumption is associated with high levels of high-density lipoproteins (HDLs). Moreover, changes in the fatty acid patterns of red blood cell phospholipids and plasma lipids have been observed in drinkers. The objectives of this study were to characterize the composition of HDL particles with respect to lipid molecular species in regular wine drinkers and to assess the functional properties of those HDLs as regards key steps of reverse cholesterol transport. METHODS: Forty-six subjects were recruited in the frame of a population study performed in Toulouse, southern France, and a nutritional investigation, including daily alcohol consumption, was performed. Subjects were sorted according to their daily alcohol intake (0, < or =35, and >35 g/day), mostly as red wine. The plasma HDL fraction was isolated, and neutral lipid molecular lipids and phospholipid fatty acids were analyzed by gas liquid chromatography. Efflux of cellular cholesterol and rates of cholesterol esterification and cholesteryl ester transfers between lipoproteins were assayed in a cell-plasma incubation system. RESULTS: Wine drinking, at 47 g/day, was associated with an increase in HDL cholesterol and apolipoprotein A-I, but not with triglycerides. Isolated HDL displayed a 27% increase in all cholesteryl ester molecular species. The particles were also enriched in unsaturated phospholipids and, particularly, in those containing arachidonic (+30%) and eicosapentaenoic (+90%) acids. The plasma cholesterol esterification rate, reflecting lecithin cholesterol acyl transferase activity on HDL, was found to be higher (+27%) in drinkers than in nondrinkers, whereas the rate of cellular cholesterol efflux to plasma was identical. CONCLUSIONS: Regular wine consumption is associated with high levels of polyunsaturated lipids in HDL and with increases in the cholesterol esterification rate.

Epidemiological studies suggest that the consumption of wine, particularly of red wine, reduces the incidence of mortality and morbidity from coronary heart disease. This has given rise to what is now popularly termed the "French paradox". The cardioprotective effect has been attributed to antioxidants present in the polyphenol fraction of red wine. Grapes contain a variety of antioxidants, including resveratrol, catechin, epicatechin and proanthocyanidins. Of these, resveratrol is present mainly in grape skin while proanthocyanidin is present in the seeds. In this report, we provide evidence that red wine extract as well as resveratrol and proanthocyanidins are equally effective in reducing myocardial ischemic reperfusion injury, which suggests that these red wine polyphenolic antioxidants play a crucial role in cardioprotection.

The body responds to stress through a hormone system called the hypothalamic-pituitary-adrenal (HPA) axis. Stimulation of this system results in the secretion of stress hormones (i.e., glucocorticoids). Chronic excessive glucocorticoid secretion can have adverse health effects, such as Cushing's syndrome. Alcohol intoxication activates the HPA axis and results in elevated glucocorticoid levels. Ironically, elevated levels of these stress hormones may contribute to alcohol's pleasurable effects. With chronic alcohol consumption, however, tolerance may develop to alcohol's HPA axis-activating effects. Chronic alcohol consumption, as well as chronic glucocorticoid exposure, can result in premature and/or exaggerated aging. Furthermore, the aging process affects a person's sensitivity to alcohol and HPA axis function. Thus, a three-way interaction exists among alcohol consumption, HPA axis activity, and the aging process. The aging process may impair the HPA axis' ability to adapt to chronic alcohol exposure. Furthermore, HPA axis activation may contribute to the premature or exaggerated aging associated with chronic alcohol consumption.

An extract from red-wine grape fermentation, ANOX has been developed as a source of red-wine polyphenols, which are thought to inhibit several of the pathogenic pathways that lead to cardiovascular disease. New data indicate that this extract has a significantly greater effect than either red wine or red-wine powder on the inhibition of platelet aggregation in vitro. Based on this data, about 300 - 500 mg of the extract is equivalent to the daily dose of red-wine polyphenols that appears to protect against cardiovascular disease. The possible synergistic effect of red-wine polyphenols with vitamin C, their vasorelaxing activity and their possible role in preventing over-crosslinking of connective tissues (premature ageing) are considered. The extract contains standardized amounts of the whole spectrum of polyphenolic compounds found in red wine and may provide a valuable reference substance in clinical investigations of the physiological actions of plant polyphenols; its potential use in functional nutrition and preventive medicine is also discussed.

Wine has been part of human culture for 6,000 years, serving dietary and socio-religious functions. Its production takes place on every continent, and its chemical composition is profoundly influenced by enological techniques, the grape cultivar from which it originates, and climatic factors. In addition to ethanol, which in moderate consumption can reduce mortality from coronary heart disease by increasing high-density lipoprotein cholesterol and inhibiting platelet aggregation, wine (especially red wine) contains a range of polyphenols that have desirable biological properties. These include the phenolic acids (p-coumaric, cinnamic, caffeic, gentisic, ferulic, and vanillic acids), trihydroxy stilbenes (resveratrol and polydatin), and flavonoids (catechin, epicatechin, and quercetin). They are synthesized by a common pathway from phenylalanine involving polyketide condensation reactions. Metabolic regulation is provided by competition between resveratrol synthase and chalcone synthase for a common precursor pool of acyl-CoA derivatives. Polymeric aggregation gives rise, in turn to the viniferins (potent antifungal agents) and procyanidins (strong antioxidants that also inhibit platelet aggregation). The antioxidant effects of red wine and of its major polyphenols have been demonstrated in many experimental systems spanning the range from in vitro studies (human low-density lipoprotein, liposomes, macrophages, cultured cells) to investigations in healthy human subjects. Several of these compounds (notably catechin, quercetin, and resveratrol) promote nitric oxide production by vascular endothelium; inhibit the synthesis of thromboxane in platelets and leukotriene in neutrophils, modulate the synthesis and secretion of lipoproteins in whole animals and human cell lines, and arrest tumour growth as well as inhibit carcinogenesis in different experimental models. Target mechanisms to account for these effects include inhibition of phospholipase A2 and cyclo-oxygenase, inhibition of phosphodiesterase with increase in cyclic nucleotide concentrations, and inhibition of several protein kinases involved in cell signalling. Although their bioavailability remains to be fully established, red wine provides a more favourable milieu than fruits and vegetables, their other dietary source in humans.