Abusive Consumption of Alcohol by Elderly

Methods: This is a cross-sectional, descriptive study, with quantitative approach with a sample of 170 elderly. To perform the study, three instruments were used: the Mini Mental State Examination (MMSE), a sociodemographic questionnaire and the Michigan Alcoholism Screening Test Geriatric Version (MAST-G). The data were analyzed in the program Statistical Package for Social Sciences (SPSS version 21).


Introduction
Population aging, once seen as a phenomenon, has become a worldwide reality.This is due to the change in some health indicators, especially the fall in fertility and mortality rates and the increase in the population's life expectancy.It should be pointed out that the phenomenon of the population increase competing with an increase in life expectancy has been emerging among developed countries for a longer time, followed by smaller economies, such as developing countries [1].In Brazil, the elderly population rose from 14.2 million in 2000 to 19.6 million in 2010 and it is estimated that by 2030 this population reaches 41.5 million elderly people [2,3].
Thus, it is important to emphasize that the aging process occurs naturally and causes to the human being continuous and inevitable changes that happen regardless of a good health condition or healthy lifestyle.It is also worth noting that this process presents challenges, where on the one hand there is the reflection of advances achieved in relation to health and living conditions, highlighting humanity's progress in increasing life expectancy, and on the other hand there is a growing possibility of the development of degenerative and chronic diseases, compromising the autonomy and independence of the affected elderly [4,5,6].This dubious reality imposes the need for investments in research and inputs that improve the quality of life of the elderly, since this is an already concrete reality in every part of the world.
Therefore, addressing the issue of aging requires that something of an urgent nature be achieved.The Brazilian reality indicates an important percentage of the elderly, which will increase in the coming years, which demands specialized public services, which are a reflection of the current planning and priorities of social public policies.It is worth emphasizing that they have integrated interventions that ensure care for chronic diseases, but that strengthen the promotion of healthy and active aging of these citizens [6].
It can not be forgotten to point out that senility brings on the individual changes that go beyond the biological, passing through emotional, economic and social issues.Among the social problems, the elderly may present greater vulnerability and predisposition to alcohol and other drugs consump-tion, due to changes in their daily lives such as: retirement, loss of loved relatives, social withdrawal and solitude, drug abuse, physical and psychological weakness, among others.Therefore, the analysis of these factors can be seen not only in an isolated perspective, since in most cases they are intertwined, that is, one fact may be influencing or triggering another [7,8].
Alcohol has been singled out as one of the drugs most consumed or at least tried in Brazil.According to data obtained in the first household survey on psychotropic drugs in the country, the percentage of alcohol dependence was estimated at 11.2% in the Brazilian population, and the North and Northeast regions had the highest consumption index, with percentages above 16%.Epidemiological data on patterns of alcohol consumption in the Brazilian population indicate that 7% of the elderly consume alcohol frequently, 8% very frequently, 10% occasionally, 8% rarely and 68% are abstainers or never drink [9].
Therefore, alcohol is characterized as a licit drug, and its consumption is often admitted and encouraged by social habits in several countries, in which the age for onset of consumption has been decreasing, gradually increasing the closure of use of that substance for higher and higher ages [1].And its early diagnosis, as well as treatment, play a crucial role in the prognosis, which expands in a global perspective of prevention, health promotion, shorter hospitalization time and better quality of life [10].
In this sense, it is highlighted that the elderly can present several health problems due to the physiological aging, due to this, their routine is usually altered with the inclusion of medications with daily doses that aim at the cure or control of the disease.However, such drugs, when associated with alcohol consumption, make the elderly more susceptible to interactions and complications of the health condition [7].
In this way, the epidemiological transition, while modifying the dynamicity of a population, requires that the way of carrying out the health process in that society is simultaneously changed.The professional should understand the new social order, predict the emergence of new patterns for health problems in order to define strategic plans for the target population, as well as socially include these people.In this scenario, the elderly are demanding more attention, since the tendency to become a majority in the population and with consequent increase in the diseases prevalent in senility that are more susceptible to situations and that can be prevented through immediate actions that involve health professionals, State and community.
Thus, alcoholism is inserted in this context when the elderly see in the drink an escape from their problems and a means to experience or revive pleasures that the youth had once made possible, starting perhaps an anecdotal picture, referring to the decrease in capacity that the subject has to feel joys or sensation of pleasure.
Therefore, in order to collaborate with research and diagnosis of alcohol dependence in the elderly, nurses and health professionals in general can contribute to the elaboration and use of specific instruments for the investigation of alcohol consumption, and propose appropriate strategies aimed at the prevention or reduction of the negative effects of alcohol use in the elderly population.This study aimed to investigate the use and abuse of alcohol in the elderly in the city of Santa Cruz -PB.

Methods
This is a cross-sectional, descriptive study, of quantitative approach, carried out in the city of Santa Cruz, located in High Backwoods of Paraíba, Brazil.This municipality has 210,165 km² of territorial area and population density of 30.79 inhabitants per km².Its population is estimated at 6,576 inhabitants, of which 1,203 are aged to 60 years or over [2].
The population of this study was composed of 304 elderly enrolled in the Family Health Strategy (ESF), Doctor João Ivani Saudanha in the municipality of Santa Cruz-PB and the sample was composed of 170 elderly.Inclusion criteria for sample composition were: age greater than or equal to 60 years and preserved the cognitive status.As exclusion criteria, there were considered unfit to respond to the objectives of the study, the elderly who no longer reside in the municipality and those with communication difficulties to respond to the questionnaires used.
In this study, three instruments were used: the Mini Mental State Examination (MMSE), a sociodemographic questionnaire and the Michigan Alcoholism Screening Test -Geriatric Version (MAST-G).
The first instrument applied was the MMSE, which aimed to assess the mental state of the study participants, thus ensuring the absence of dementia and sample quality.The MMSE consists of a questionnaire divided into six groups: temporal and spatial orientation, records, attention and calculation, recall or memory of evocation and language [11].
After demonstrating the absence of dementia, a sociodemographic questionnaire was applied, consisting of twelve questions and then used the MAST-G instrument that is specific for the elderly and allows investigating the use, abuse and probable dependence of alcohol in this population.It consists of 24 dichotomous questions, YES and NO, where each YES answer corresponds to 01 [one] point.His cut grade is 5, that is, a score equal to or higher than 5 indicates the possibility of the individual presenting problems related to alcohol use [12].
The data were analyzed in the program Statistical Package for Social Sciences (SPSS -version 21).To estimate the associations between alcohol problems and biosociodemographic variables, bivariate logistic regressions were adopted.The bivariate associations were initially estimated, and in the final model were considered those that presented a significance less than or equal to 0.2 and as input method the forward conditional.It was accepted as statistically significant p <0.05.This research followed the ethical precepts proposed in Resolution 466/12, assuring the participants, complete privacy and confidentiality of the information that was collected, using them exclusively for scientific and academic purposes.The project was approved by the Ethics and Research Committee of the Federal University of Campina Grande, under opinion number 1,311,644.

Results
The sample consisted of 170 [55.9%) elderly individuals aged 60 years or older, of both sexes.
All the elderly answered the Mini State Mental Examination (MMSE) and the calculated mean score was 20 points (Dp ± 3.6) on a scale from 0 to 30, with 21 points (Dp ± 3.8) for the elderly women and 20 points (Dp ± 3.4) for the elderly men.
Regarding alcohol use and abuse, of the 170 elderly people who composed the sample, 25 (14.7%) were identified and classified by the MAST-G score as elderly who present problems related to alcohol abuse.It is noteworthy that 58 (47.2%) elderly reported using alcohol.However, MAST-G only considers that the elderly have problems with drinking when they respond to 5 (five) or more questions on the instrument with the "YES" alternative.
The results of the study will be presented in tables, showing in Table 1 the bivariate associations between problems with alcohol and sociodemographic data.The elderly participants in the study were between 60 and 92 years of age.The majority of males, corresponding to 91 elderly, 53.5% of the cases and of these, 23.1% have problems with alcohol.And the largest number are married, 104 (61.2%), followed by 38 [22.4%) who said they were widowed, but the single elderly (33.3%) and separated (25%) are the most susceptible to alcohol.
In relation to schooling, the majority of the elderly, 88 (51.8%), had 01 to 04 years of schooling, followed by illiterate elderly, which corresponded to 72 cases (42.37%), showing a low average schooling.However, when compared to those who have problems with alcohol, 20% corresponded to the elderly with more than 5 years of study.
With regard to occupation, 138 (81.1%) of the elderly were retired and 16 (9.4%)were farmers, these being the most affected by alcohol, accounting for 25% of all bivariate associations.The monthly family income of 71 (41.8%) elderly was R $ 780.00, that is, a minimum wage, however, it was the elderly with a monthly income of more than R $ 1500.00 who have problems with alcohol.Most of the elderly, 154 (90.6%) reported living with their families, and only 16 [9.4%)declared themselves to be living alone, the latter being prevalent in alcohol problems (25%).
In the second segment, the association between alcohol problems and disease data was discussed.

(Table 2)
The study evidences that most of the elderly, 104, have some type of pathology, of these, 19 elderly, that is, 18.3% who have problems with alcohol present some clinical problem.Regarding the use of medications, 16 elderly (16.7%) with alcohol problems make use of some type of medication.(Table 3) It is verified that the effects of gender, marital status and who has disease increased when compared to the bivariate models of the previous tables.This increase may indicate that these variables can not be considered in isolation.The male sex was 8.06 times more likely to have problems with alcohol, singles 4.45 times and people with disease 4.29 times more likely to have problems with alcohol.

Discussion
Regarding the difficulty of detecting alcohol abuse in the population, it is necessary to use an instrument that facilitates this understanding, such as MAST-G, in order to produce and offer new knowledge in the area of health of the elderly person.The same is used for the detection of alcohol abuse and dependence in the elderly of both sexes, characterizing, therefore, the objective of the study [12].It is noticeable that men tend to consume alcoholic beverages in larger quantities and frequencies when compared to women, and thus expose themselves more to risk situations, which often can have devastating emotional, social, familiar and health consequences, which corroborates with a A study carried out in a city in the state of Minas Gerais, where there was also a higher prevalence of alcohol abuse in elderly male patients and that is, as the age increases, the time of use is increased, so, the elderly are those who present the highest average of time of alcohol consumption [13,14], this reality tends to favor the increase of deleterious effects on the health, especially emotional, of the elderly [2].
Regarding marital status, it was observed that the majority of elderly individuals who presented problems with alcohol were single, being in this way, in agreement with the literature that points out as one of the most common sociodemographic factors among alcoholics the condition of single, separated or divorced.In this way, it can be evidenced that being married or having a partner is considered as a protective factor for problematic alcohol consumption.Especially among men, since women often contribute to their health care, advising them not to consume too much alcohol and to be an example for the family [14,15].
As for the level of schooling, it is perceived that alcoholism is characterized by a condition that does not choose who affects it, it simply surprises the most susceptible individuals, and that they are not strong to the same, and they end up living dependent.It is therefore a problem in the public health field, which is often having to deal with the elderly dependent population.Illiterate elderly people, with little education, with a higher level of knowledge are subject, and this is due to negligence, mistreatment, abandonment, family violence [16].
As presented, elderly people who have problems with alcohol are those who live alone and this favors even more the unfolding of this situation, since they do not have family support, and therefore, they hardly find any reason to identify the excessive consumption and to accede to therapeutic resources to contain the habit of abusive use of alcohol, and this situation becomes a preponderant factor for the alcoholist to deny their condition of dependence, and then seek treatment [13].
As shown in the study, the majority of the elderly have a monthly income of a minimum wage, but it was the elderly with incomes of more than R $ 1500.00 that presented more problems with alcohol, as opposed to that found in the literature, in that some authors affirm that the consumption of alcoholic is present in all social classes, however, the majority points to a higher frequency of consumption in lower income populations [17,1].
However, this condition should be an impediment to alcohol consumption, since it could imply less resources for buying beverages, besides restricting the participation in social activities involving drug use, causing the individuals with higher income levels to have more favorable conditions for drinking, thus being the situation characterized in the present research [18].
In the study, elderly people who have problems with alcohol also have some type of pathology.Therefore, it is worth emphasizing that the aging process can occur in a healthy way and that despite this, the elderly are not free to develop any degenerative or chronic disease along this route, so if it occurs in an unhealthy way, it can develop in a committed way.And alcohol is undoubtedly an aggravating factor in the third age, affecting the life of the elderly in addition to their current health status [19].
Thus, elderly people afflicted with some chronic illness tend to have a worsening of their clinical condition over time, and excessive alcohol consumption will significantly affect this process.This is why it is of great importance to take action to combat this condition in order to guide people about the risks of consumption and the benefits arising from their interruption [20].
In the context of the use of the medication, it was verified that elderly people who present problems with alcohol take medication regularly, and most of them usually use for the treatment of chronic diseases, such as Systemic Arterial Hypertension (HBV) and Diabetes Mellitus (DM).It is worth mentioning that one of the ways to control hypertension is through alcohol restriction.With regard to DM, the abusive intake of alcohol causes vasodilatation, providing a peripheral uptake of glucose through the blood and also insufficiency of insulin by the pancreas, resulting in alcoholic diabetes that can be overcome from the alcohol suspension, which leads to a reflection about the problem that abusive use of alcohol causes in the life of the elderly [21,22].
Therefore, the study that variables, gender, marital status and disease are possible predictors of this consumption, men, single and presenting some type of pathology, mainly chronic, make up a group with a higher risk for problematic alcohol use, and thus, more likely to increase morbidity and mortality related to alcohol consumption [23].
Therefore, it can be emphasized that in most research on the subject the predominant clientele are single males, which may be related to the culture of alcohol use predominantly by males, and by persons without established civil unions.And in relation to the presence of disease, which should stimulate more careful / healthy life habits, it is a risk factor for the problem with alcohol [13].
Regarding not having a significant number of women who report problems with alcohol, a study carried out in Minas Gerais indicates that, for the female, there is a very expressive predominance of diverse feelings that may reflect a condition of guilt or shame characterized by discrimination in taking drugs in general [1], this context repeats the studied universe where there is no evidence related to the female gender and alcohol consumption.
The rapid diagnosis by the professional of the abusive consumption of alcohol and / or other drugs by the elderly can determine the outcome of the health condition of this subject, for this, it is essential for health professionals to be enabled with instruments and models of service that allows them to act in this reality, which already indicates a high tendency to increase.The rapid changes in the epidemiological profile require immediate actions of effective public policies and multiprofessional action in order to reduce the effects that alcohol consumption causes the elderly.Motivational interviews have been used as a therapeutic resource in groups of people addicted to alcohol, with a positive advance in reducing consumption [24].

Conclusion
In the research, it was evidenced that of the 170 elderly, 25 (14.7%) were classified by the MAST-G score as elderly who presented problems related to alcohol abuse, most of them male, single, over 5 years old of study, who reside alone, and present some pathology and makes use of medications.
It is clear that alcoholism in the elderly is a major challenge, requiring permanent investments in education and health, which makes essential to reorganize services so that, based on identified vulnerabilities, can be considered care priorities, so thet the harmful effects of alcohol as well as the various barriers involved in identifying the problem can be minimized or even extinguished, contributing to the demystification of alcohol consumption in the elderly.
In view of this fact, it is necessary that the multidisciplinary team in health of Primary Care, can elaborate activities that include the prevention of alcohol consumption, in order to provide coping actions and the reduction of undesirable events associated to damages caused by the use of drugs, whether of a licit nature or not.
The early and effective diagnosis, the debate about the issue of alcohol use in old age by men and women, and models of attendance outside prejudices and stereotypes, mainly in Primary Care, tend to reduce this reality, evidencing what the most developed countries already begin to implement, that it is a healthy and active old for this part of the society.
It is pointed out as a limitation of the study the transversal design, which does not allow to conclude on causality among the investigated factors, as well as to be dealing with self-referred responses.

Table 1 .
Bivariate associations between alcohol problems and sociodemographic data.

Table 2 .
Association between alcohol problems and disease data.

Table 3 .
Multivariate association with alcohol problems.