|Year : 2019 | Volume
| Issue : 4 | Page : 230-234
Alcoholism amongst geriatric patients attending general practice clinic of a Teaching Hospital in Benin City, Nigeria
Ehigiator Okohue Adayonfo1, Afolabi Joseph Adewole2, Mary Ehimigbai1
1 Department of Mental Health, University of Benin Teaching Hospital, Benin City, Nigeria
2 Department of Family Medicine, University of Benin Teaching Hospital, Benin City, Nigeria
|Date of Web Publication||4-Oct-2019|
Dr. Mary Ehimigbai
Department of Mental Health, University of Benin, Benin City
Source of Support: None, Conflict of Interest: None
Context: Alcoholism or alcohol use disorder (AUD) is common among the elderly, though under-recognised and underreported. This under-reporting is especially so in Africa, including Nigeria where there is near absence of study on the subject matter. Aims: This study aims to determine the prevalence of alcoholism amongst geriatric patients at the general practice clinic (GPC) of a teaching hospital and to assess some associated socio-demographic factors. Materials and Methods: The study was cross-sectional and descriptive, conducted at the GPC of the University of Benin Teaching Hospital, Benin City, Nigeria. Four hundred and twenty-two geriatric outpatients completed the geriatric version of the Short Michigan Alcoholism Screening Test and a socio-demographic data collection sheet. Cross-tabulation of categorical variables was performed by means of IBM SPSS statistics for windows version 19.0, with the level of significance set at P <0.05. Results: The prevalence of AUD was 10.2%; the prevalence amongst males and females was 18.1% and 5.3%, respectively. AUD was present in 14.4%, 6.84% and 4.55% of those who had marital conflict, chronic pain and difficulty with walking, respectively. Sex, age group, financial difficulty, chronic pain and difficulty with walking were significantly associated with AUD. Conclusions: The prevalence of AUD amongst geriatric patients is relatively high. The deleterious effects of alcoholism may be worse in the elderly due to changes that occur with aging and their likelihood to be on medications that may interact adversely with alcohol.
Keywords: Alcoholism, general practice clinic, geriatrics, prevalence
|How to cite this article:|
Adayonfo EO, Adewole AJ, Ehimigbai M. Alcoholism amongst geriatric patients attending general practice clinic of a Teaching Hospital in Benin City, Nigeria. Niger Postgrad Med J 2019;26:230-4
|How to cite this URL:|
Adayonfo EO, Adewole AJ, Ehimigbai M. Alcoholism amongst geriatric patients attending general practice clinic of a Teaching Hospital in Benin City, Nigeria. Niger Postgrad Med J [serial online] 2019 [cited 2019 Dec 14];26:230-4. Available from: http://www.npmj.org/text.asp?2019/26/4/230/268599
| Introduction|| |
Alcoholism or alcohol use disorder (AUD) is common among the elderly, though under recognised  and therefore underreported. This under-reporting is especially so in Africa, including Nigeria, where there is near absence of study on the subject matter. Ironically, the deleterious effects of alcohol may be worse in the elderly because of changes that arise with aging and the likelihood of being on medications that have adverse interaction with alcohol. Two-thirds of elderly people who have AUD have early-onset type while one-third has the late-onset type. The early-onset type describes a situation where the individual has had a lifelong AUD pattern while the late-onset type refers to AUD developing at 40–50 years of age.,,,
In the health-care settings, 7.5%–75% of the elderly have been reported to have illness linked to AUD., A study conducted in Thailand reported that 20.3% of 11,418 older patients hospitalised for mental and behavioural disorders was due to the use of alcohol. Community samples show that 2.36% of men meet criteria for alcohol abuse. Meanwhile, 6%–11% of elderly on admission manifests features of alcoholism; this increasing to 20% on a psychiatric ward and reducing to 14% in emergency rooms. Among the elderly in the nursing home, the prevalence of AUD may be as high as 49%.
The implications of AUD in the elderly are legion. It includes physical, psychological and social consequences. Accidents, falls, cerebrovascular accident, heart disease, hypertension, gastrointestinal symptoms, insomnia, osteoporosis, delirium tremens, Parkinson's disease, poor hygiene, poor nutrition, hypothermia, liver cirrhosis and various cancers may be complications of AUD in the elderly.,,,,
Regrettably, there is a near absence of data on AUD among the elderly in Africa, including Nigeria. Therefore, the aim of this study was to determine the prevalence of alcoholism among geriatric patients at the general practice clinic (GPC) of the University of Benin Teaching Hospital (UBTH) and to elicit socio-demographic and other factors that may be associated with AUD among this special population. It is hoped that the findings may bring to the fore the issue of AUD among the elderly and also make recommendations that may help to mitigate the same.
| Materials and Methods|| |
Subjects and methods
The study is a descriptive cross-sectional in design, conducted over a 3 months' period, from August to November 2018. Ethical clearance was obtained from the Ethics and Research Committee of the UBTH, Benin City, Nigeria, with the protocol number ADM/E 22/A/VOL. VII/14743 dated 9th May 2019. It was amongst elderly patients (who were 60-year-old and above) attending the GPC of the UBTH, Benin City, Edo State, Nigeria. Informed consent was obtained from all the participants.
UBTH is one of the first-generation teaching hospitals in Nigeria, founded in 1973. It complements the University of Benin and trains high- and middle-level workforce for the health-care industry, providing an avenue for research by lecturers of the university. The hospital has over 900 beds. The GPC is an outpatient clinic, managed by the Department of Family Medicine. It has geriatric and general outpatient clinics, and services the National Health Insurance Scheme; all running for 7 days in a week from 8 am to 6 pm daily. All age groups and both gender are attended to in the clinic. On an average, 220 patients are seen daily from Monday to Friday and about 80 patients daily from Saturday to Sunday. About 12–15 new elderly patients are seen daily.
The sample size was calculated using the Fisher's formula:
Where n = the desired sample size
z = standard normal deviate, set at 1.96, which correspond to 95% confidence level.
p = the prevalence of alcoholism among older adults. The prevalence of 50% was adopted since there is no prior study in this environment.
q = 1 − p. 1 − 0.50 = 0.50
d = degree of precision = 5% =0.05
Thus, the minimum sample size required was 384. Using 10% attrition rate, it was increased to 422 to accommodate incompletely filled or missing questionnaires. Record obtained from the Department of Family Medicine UBTH to determine the number of elderly patients attended to at GPC over the preceding 3 months before the study showed that a total of 1130 elderly patients were attended to. Thus, the sampling interval was determined to be three. Thereafter, every third elderly patient was selected until the sample size was reached. The first participant was determined by balloting from amongst the geriatric patients present on the 1st day of questionnaire administration.
The instrument used for the study consisted of two sections.
Section 1 - A data collection sheet used to obtain information about some socio-demographic characteristics of the respondents. This included questions about age, sex, marital status, presence of conflict in the home, financial difficulty, chronic pain and experience of loneliness.
Section 2 - The geriatric version of the Short Michigan Alcoholism Screening Test (SMAST): The MAST is a 24-item questionnaire developed in 1971. The MAST is the most frequently used instrument for screening for alcoholism, and it may be self or observer rated., The SMAST-Geriatric (SMAST-G) version is a modified version of MAST, used to screen for alcoholism in the geriatric population. It has 10 items, and each item is followed by a 'yes' or 'no'. The respondent is asked to mark yes or no for each item. One point is scored for each 'yes' answer and 0 for each 'no' answer. The total score is arrived at by adding the scores on each item. Therefore, the total score ranges from 0 to 10. A score of 2 and above is indicative of the alcohol problem. The SMAST-G has a sensitivity of 93.9%, specificity of 78.1%, a positive predictive value of 87.2% and a negative predictive value of 88.9%. The instrument was completed by the participants.
- Participants must be at least 60-year-old
- The patient must give informed consent.
- Those who do not read or write English language
- Any patient that is cognitively impaired or too ill to participate.
Data management and analysis
The data were analysed using the IBM SPSS statistics for windows version 19.0 (Armonk, NY, USA: IBM Corp, 2010). The statistics used included univariate analysis and Chi-square test. The statistical level of significance was set at the 5% level (P< 0.05).
| Results|| |
Four hundred and twenty-two questionnaires were administered, but 392 questionnaires were analysed, giving a response rate of 92.9%. Others were discarded owing to missing data or ambiguous responses. The prevalence of AUD was 10.2% (40/392), while the prevalence amongst males and females was 18.1% (27/149) and 5.3% (13/243), respectively. The age range was 60–83 years; mean age being 70± (7.4) years, while the modal age was 60 years. All the respondents were Christians.
Most of the respondents were females (62.0%) and 27.6% were in the age group of 65–69 years with 72.4% married. Only 3.6% reported that they were lonely and 24.2% reported the presence of family conflict. While 72.2% reported not having financial difficulty, almost half, 48.5% had chronic pain. Twenty point one AUD was present in 14.4%, 6.84% and 4.55% of those who had marital conflict, chronic pain and difficulty with walking, respectively, per cent had sleep difficulty while 12.4% experienced difficulty with walking [Table 1] and [Table 2].
|Table 2: The association between characteristics of the respondents and alcohol use disorder|
Click here to view
| Discussion|| |
This study showed that more women than men attended the GPC. This is not unusual as women have better health-seeking habit than men; women are more likely to use public health facilities such as this study centre and are reportedly more sensitive to their health. Similar findings were reported by some authors in their work on the influence of gender and other patient characteristics on healthcare-seeking behaviour. Similarly, the author of a study on the determinants of health-seeking behaviour in a Nairobi slum, Kenya, found the coefficient on gender dummy to be negative and statistically significant in public health facilities, portending that being male reduces the likelihood of visiting public facilities relative to self-treatment.
Most of the respondents in this study had no experience of loneliness; only 3.6% reported loneliness. This is not unexpected as the majority, 72.4%, of the respondents, were married. In addition, the practise of the extended family system is the norm in Africa where this study was conducted. Previous authors in their work on marriage, family and loneliness found that marriage prevents loneliness.
In addition, this study showed that alcohol use was not statistically related to loneliness. However, there are opposing reports in the literature. While some authors reported loneliness to be associated with reduced frequency of alcohol, others reported significant positive association of loneliness to alcohol use at all stages in the course of alcoholism; including it being a contributing and maintaining factor and a hindrance to attempts at abstinence., The prevalent practise of the extended family system could account both for the low level of loneliness and lack of its association with problematic alcohol use. They may be taking alcohol within acceptable guidelines and may also have diverse social networks which may negate their significant use of alcohol even in their lonely state. It has been reported that loneliness does not always equate to poor social interaction. The gender was significantly related to alcohol use in this study; more men than women used alcohol. This is not unexpected because in Africa, the use of alcohol is emblematic of men's attitude and women who use alcohol are considered errant. In addition, women roles are expected to be restricted to the house while men enjoy outdoor life which involves the use of alcohol. This supports findings in a previous study which reported that, despite variations in gender ratios, men still surpass women in drinking and that lifetime abstinence is more prevalent amongst women.,
Family conflict was present in only 24.2% of the respondents, and it was not statistically related to use of alcohol. In Africa, where family values are kept even in the face of challenges, report of family conflicts is usually denied. The level of alcohol intake amongst the elderly might not be sufficient to cause family conflict. In addition, the existence of strong family ties can make an elderly 'alcoholic' accepted in the family without much scuffles.
The financial difficulty was reported by 27.8% of the respondents, and this was significantly related to alcohol use. This finding supports report by Mulia et al. that severe economic loss was positively associated with negative drinking consequences, alcohol dependence and drunkenness. The addictive nature of alcohol use can lead to disastrous spending of their little income and can also prevent them from engaging in 'financially productive activity'. More so, most alcoholics do not have productive work, and they often spend the most useful time sitting at a drink. Furthermore, being elderly, their source of income might be limited to their pension which is not regular in Nigeria. The diversion of their meagre salary to finance their drinking pattern might explain why alcohol use is related to financial difficulty. In addition, loss of gainful employment at this age can lead to increased consumption of alcohol with further increase in the level of financial difficulties; creating a vicious cycle. However, a cause and effect relationship cannot be established in this study.
The majority of those who have chronic pain do not use alcohol. Chronic pain was reported by only 6.84% of the respondents. However, this was statistically significant. Previous authors have reported chronic pain to be a reason for the use of alcohol amongst the elderly as its use might suppress pain. There was a significant relationship between alcohol use and walking difficulty in this study. The study was done among elderly respondents who are prone to having arthritis affecting major joints as a part of the ageing process. With additional pathology from alcohol use, there may be increase in the prevalence of walking difficulty amongst the respondents. Alcoholic myopathy and trauma from multiple falls can be a cause of difficulty with walking.
| Conclusions|| |
The prevalence of AUD among geriatric patients is relatively high. The study also found a significant association between AUD and sex, age group 60–69 years, financial difficulty, chronic pain and difficulty with walking. The deleterious effects of alcoholism may be worse in the elderly due to changes that occur with ageing and also they are likely to be on medications that may interact adversely with alcohol; more so, the presence of co-morbidities, requiring frequent use of multiple drugs and a visit to pharmaceutical stores are reportedly high in the elderly., There is, therefore, need for intervention programmes for the elderly.
The cross-sectional design of this study limits the reliability of the assessment of the relationship between alcoholism and some socio-demographic variables. Future prospective or longitudinal study design is advocated to test directionality with a view to establishing a cause and effect.
The authors would like to acknowledge all the patients that painstakingly participated in this study. Many thanks also to the research assistants who helped to distribute and retrieve the self- administered questionnaires. We also like to acknowledge Michael Memorial Specialist Mental Health and Addictions Clinic, Iguosa, Benin City, Nigeria, for providing secretariat support for the manuscript.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2]