The number of elderly is growing in Europe. Two recent studies looked at the association between alcohol consumption and frailty among this group. Elderly who consume alcohol (up to 40 g/day) appear to have a lower risk of frailty compared to their non-drinking peers. It is unclear what causes this association and whether confounding factors are playing a role. The results were recently published in the scientific journals Age and Ageing and Bioscience Trends.

What is already known? The number of frail elderly is increasing in Europe. There is limited research on the association between alcohol use and frailty.

What does this study add? This study is the first meta-analysis looking at the associations between alcohol consumption and frailty among older adults. The mechanism behind the association is still unknown.

Lower risk
In a first analysis, the researchers looked at the results of four previous studies including over 44,000 elderly in total. Compared to non-drinkers, elderly who consume alcohol have a 39% lower risk of frailty1.
A second analysis, specifically looked at the dose-response association and included data from three studies with in total over 30,000 elderly. The results of this analysis show a J-shaped curve. The lowest risk of frailty is seen at an intake of 15 g alcohol per day. Also with higher intakes (up to 40 g/day) the risk of frailty is still lower compared to non-drinkers2. No data was available for intakes above 40g/day, and the association for higher intakes is therefore unknown.
It is important to note that in both analyses potential confounders were not taken into account. The association can therefore be influenced by other factors.

Although the mechanism is not investigated, the researchers describe two possible explanations for the association between alcohol and frailty. On the one hand, large amounts of alcohol could contribute to the frailty among elderly because of alcohol-related health consequences. On the other hand, moderate alcohol consumption decreases the risk of mortality, which could be related to frailty. Another explanation suggested by the researchers is that alcohol could contribute to social bonding and therefore reduce frailty.

Frailty is an age-related condition with increased vulnerability to adverse health outcomes, such as falls, fractures, disability and in severe cases admission in a hospital or nursery home1. With a rapidly ageing population, there is more focus on research in the population group. The WHO estimates that the proportion of people of 65 years and older will increase from 14% in 2010 to 25% in 2050 in Europe.

Strengths of this study
• Dose-response relation was investigated.
• Studies from different western countries were taken into account (Europe and US).

Limitations of this study
• The results of the studies are unadjusted for potential confounding factors.
• Limited number of studies available on alcohol and frailty.
• Studies that were taken into account had different definitions for alcohol consumption (both amount and frequency).
• Non-drinkers are used as reference group. This group could include so called ‘sick-quitters’.
• The follow-up period was relatively short (2-3.3 years). More time might be needed to observe the development of frailty.
• The highest amount of alcohol intake was 40 g/day.

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