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      Alcohol and older people from a public health perspective Translated title: Alcol e anziani in una prospettiva di salute pubblica

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          Abstract

          OBJECTIVES AND METHODS: As part of the European project VINTAGE, a systematic review of scientific literature was undertaken to document the evidence base on the impact of alcohol on the health and well-being of older people, and on effective policies and preventive approaches to face the problem in this steadily increasing segment of the population. RESULTS: 369 references were identified, from which 78 papers were selected. CONCLUSIONS: The review confirms the paucity of data on this topic and the need for more specific research. Although there is scarce evidence, the elderly seems to respond equally well to alcohol policy, screening instruments and brief interventions as do younger adults. According to a lifecycle approach, a future focus on the middle aged is also recommended.

          Translated abstract

          OBIETTIVI E METODI: Nell'ambito del progetto europeo VINTAGE, è stata condotta una revisione sistematica della letteratura scientifica, al fine di fornire la base di evidenza sull'impatto del consumo di alcol sulla salute e il benessere degli anziani, e su misure e interventi di prevenzione efficaci nel fronteggiare il problema in questo segmento della popolazione in costante aumento. RISULTATI: Dai 369 riferimenti bibliografici identificati, sono stati selezionati 78 articoli. CONCLUSIONI: La revisione conferma la carenza di dati sull'argomento e la necessità di ricerche mirate. Nonostante la scarsità di evidenze, sembra che gli anziani rispondano altrettanto bene degli adulti alle politiche sull'alcol, agli strumenti di screening e all'intervento breve. In un'ottica che investe l'intero arco della vita, si raccomanda di focalizzare gli interventi futuri anche sugli adulti.

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          Accuracy of death certificates for coding coronary heart disease as the cause of death.

          Death certificates are widely used in epidemiologic and clinical investigations and for national statistics. To examine the accuracy of death certificates for coding coronary heart disease as the underlying cause of death. Community-based inception cohort followed since 1948. Framingham, Massachusetts. 2683 deceased Framingham Heart Study participants. Sensitivity, specificity, and predictive values of the death certificate. The reference standard was cause of death adjudicated by a panel of three physicians. Among 2683 decedents, the death certificate coded coronary heart disease as the underlying cause of death for 942; the physician panel assigned coronary heart disease for 758. The death certificate had a sensitivity of 83.8% (95% CI, 81.1 % to 86.4%), positive predictive value of 67.4% (CI, 64.4% to 70.4%), specificity of 84.1% (CI, 82.4% to 85.7%), and negative predictive value of 92.9% (CI, 91.7% to 94.1%) for coronary heart disease. The death certificate assigned coronary heart disease in 51.2% of 242 deaths (9.0% of total deaths) for which the physician panel could not determine a cause. Compared with the physician panel, the death certificate attributed 24.3% more deaths to coronary heart disease overall and more than twice as many deaths to coronary heart disease in decedents who were at least 85 years of age. When deaths that were assigned unknown cause by the physician panel were excluded, the death certificate still assigned more deaths to coronary heart disease (7.9% overall and 43.1% in the oldest age group). Coronary heart disease may be overrepresented as a cause of death on death certificates. National mortality statistics, which are based on death certificate data, may overestimate the frequency of coronary heart disease by 7.9% to 24.3% overall and by as much as two-fold in older persons.
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            Behavioral determinants of healthy aging.

            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.
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              Alcohol, dementia and cognitive decline in the elderly: a systematic review.

              dementia and cognitive decline have been linked to cardiovascular risk. Alcohol has known negative effects in large quantities but may be protective for the cardiovascular system in smaller amounts. Effect of alcohol intake may be greater in the elderly and may impact on cognition. to evaluate the evidence for any relationship between incident cognitive decline or dementia in the elderly and alcohol consumption, a systematic review and meta-analyses were carried out. Criteria for inclusion were longitudinal studies of subjects aged >or=65, with primary outcomes of incident dementia/cognitive decline. 23 studies were identified (20 epidemiological cohort, three retrospective matched case-control nested in a cohort). Meta-analyses suggest that small amounts of alcohol may be protective against dementia (random effects model, risk ratio [RR] 0.63; 95% CI 0.53-0.75) and Alzheimer's disease (RR 0.57; 0.44-0.74) but not for vascular dementia (RR 0.82; 0.50-1.35) or cognitive decline (RR 0.89; 0.67-1.17) However, studies varied, with differing lengths of follow up, measurement of alcohol intake, inclusion of true abstainers and assessment of potential confounders. because of the heterogeneity in the data these findings should be interpreted with caution. However, there is some evidence to suggest that limited alcohol intake in earlier adult life may be protective against incident dementia later.
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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Role: ND
                Journal
                aiss
                Annali dell'Istituto Superiore di Sanità
                Ann. Ist. Super. Sanità
                Istituto Superiore di Sanità (Roma )
                0021-2571
                2012
                : 48
                : 3
                : 232-247
                Affiliations
                [1 ] Maastricht University Netherlands
                [2 ] Istituto Superiore di Sanità Italy
                Article
                S0021-25712012000300004
                10.4415/ANN_12_03_04
                23007048
                64bf6912-c992-4633-937a-84e7f6bac872

                http://creativecommons.org/licenses/by/4.0/

                History
                Product

                SciELO Public Health

                Self URI (journal page): http://www.scielosp.org/scielo.php?script=sci_serial&pid=0021-2571&lng=en
                Categories
                Health Care Sciences & Services

                Health & Social care
                aged,alcohol drinking,public health,Europe,review,anziani,assunzione di alcolici,salute pubblica,Europa,rassegna

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