We used data from 3041 participants in four cohorts of community-dwelling individuals aged ≥65 years in Spain collected through a pre-pandemic face-to-face interview and a telephone interview conducted between weeks 7 to 15 after the beginning of the COVID-19 lockdown. On average, the confinement was not associated with a deterioration in lifestyle risk factors (smoking, alcohol intake, diet, or weight), except for a decreased physical activity and increased sedentary time, which reversed with the end of confinement. However, chronic pain worsened, and moderate declines in mental health, that did not seem to reverse after restrictions were lifted, were observed. Males, older adults with greater social isolation or greater feelings of loneliness, those with poorer housing conditions, as well as those with a higher prevalence of chronic morbidities were at increased risk of developing unhealthier lifestyles or mental health declines with confinement. On the other hand, previously having a greater adherence to the Mediterranean diet and doing more physical activity protected older adults from developing unhealthier lifestyles with confinement. If another lockdown were imposed during this or future pandemics, public health programs should specially address the needs of older individuals with male sex, greater social isolation, sub-optimal housing conditions, and chronic morbidities because of their greater vulnerability to the enacted movement restrictions.

Alcohol consumption is a leading cause of morbidity and mortality, accounting for approximately 5.1% of the global burden of disease and 5.3% of all deaths and being responsible for significant social and economic losses, thus representing a major public health problem.¹ Additionally, the assumed benefits of drinking low amounts of alcohol, especially on cardiovascular disease (CVD) mortality,^2-4 are being questioned due to selection biases, reverse causation, and residual confounding,⁵ supporting health messaging that the safest level of drinking is no drinking at all or less is better.^6,7 Selection biases are often overlooked, but they can lead to a systematic underestimation of alcohol-related burden. That is the case of the abstainer bias, whereby the apparently lower mortality of light drinkers compared with abstainers could be explained by the higher death risk of the abstainers because they include former drinkers who quit alcohol due to poor health, as well as lifetime abstainers,⁵ who often have worse lifestyle and health characteristics than regular drinkers.⁸ Also, the healthy drinker/survivor bias, caused by overrepresentation of healthier drinkers who have survived the deleterious effects of alcohol, can distort comparisons, especially in older age.⁵ In addition, drinking habits may influence the association between the amount of alcohol consumed and health. In this context, wine preference has been associated with lower risk of death,⁹ CVD morbimortality,¹⁰ and diabetes,¹¹ attributing the beneficial associations of wine to its high content in polyphenols.¹² Furthermore, drinking with meals has been associated with lower risk of all-cause, non-CVD, and cancer deaths¹³ and frailty,¹⁴ so this might be a safer option for alcohol drinkers along with moderate consumption.¹⁵

Consumption of moderate-to-heavy amounts of alcohol has been associated with lower risk of cardiovascular disease and diabetes. Although both diseases are main causes of the frailty syndrome, no previous study has assessed the association between alcohol-drinking patterns and risk of frailty in older adults. A prospective cohort study of 2,086 community-dwelling individuals aged 60 and older, recruited in 2008–2010, and followed through 2012, was carried out. Drinking patterns were self-reported at baseline. Moderate drinking was defined as alcohol intake less than 40g/day for men and less than 24g/day for women. A Mediterranean drinking pattern was defined as moderate alcohol intake, with wine preference (≥80% of alcohol proceeds from wine) and drinking only with meals. Study participants were followed through 2012 to ascertain incident frailty, defined as ≥2 of the following 4 Fried criteria: exhaustion, muscle weakness, low physical activity, and slow walking speed. Analyses were performed with logistic regression and adjusted for the main confounders. After a mean follow-up of 3.3 ( SD = 0.6) years, 292 participants with incident frailty were identified. Compared with nondrinkers, the odds ratio and its 95% confidence interval of frailty was 0.90 (0.65–1.25) for moderate drinkers. The corresponding results were 0.74 (0.48–1.16) for wine versus other beverage preference and 0.53 (0.31–0.92) for drinking only with meals versus only outside meals. Finally, compared with nondrinkers, the odds ratio (95% confidence interval) of frailty was 0.68 (0.47–0.99) for those adhering to the Mediterranean drinking pattern. Certain drinking patterns, in particular drinking only with meals and the Mediterranean drinking pattern, are associated with a lower risk of frailty in older adults.

Seafood consumption and dietary intake of n-3 polyunsaturated fatty acids (PUFA) protect from cardiovascular disease, muscle wasting and mortality; however, their role in delaying unhealthy ageing is uncertain. A prospective cohort study with 1592 community-dwelling individuals aged ≥60 years recruited in 2008–2010, and followed through 2015. Intake of seafood and n-3 PUFA [eicosapentanoic acid (EPA) and docosahexanoic acid (DHA)] was estimated using a validated diet history and food composition tables. Unhealthy ageing was assessed across the domains of physical and cognitive function, mental health, morbidity, self-rated health and vitality. Higher blue fish consumption was negatively associated with unhealthy ageing in 2015 [multivariate ß (95% confidence interval) per interquartile range (IQR) increase of fish: −0.49 (−0.90; −0.08)] and, specifically, was associated with lower accumulation of functional impairments [−1.00 (−1.71; −0.28)] and morbidities [−0.30 (−0.73; 0.13)]. Individuals with high intakes of EPA (≥0.47 g/day) and DHA (≥0.89 g/day) presented the highest reductions in age-related deficits accumulation: −1.61 (−3.01; −0.22) and −1.34 (−2.76; 0.08), respectively. Intake of EPA and DHA were negatively associated with the accumulation of functional deficits [results per IQR increase: −0.79 (−1.64; −0.06) and −0.84 (−1.67; −0.01), respectively] and morbidities [−0.60 (−1.10; −1.11) and −0.60 (−1.09; −0.11)]. No associations were observed between n-3 PUFA and self-rated or mental health, or between white fish and unhealthy ageing. In this cohort of Spanish individuals with elevated intake of fish and a high adherence to the Mediterranean diet, consumption of blue fish and n-3 PUFA had a prospective protective association with deficits accumulation.

The scarce research on the effects of moderate alcohol consumption on mental health among older adults suggests a protective effect against depression. We prospectively examined the association between patterns of moderate alcohol consumption, depression and psychological distress, using information from 5,299 community-dwelling older adults from the ELSA and Seniors-ENRICA cohorts. A Mediterranean drinking pattern (MDP) was defined as moderate alcohol intake (<40 g/day for men; <24 g/day for women) with a preference for wine and drinking only with meals. Depression was ascertained with the 10-item Geriatric Depression Scale (GDS-10), a self-report of clinically-diagnosed depression, or being on anti-depressant medication (Seniors-ENRICA); and with the 8-item Center for Epidemiologic Studies Depression Scale (CES-D) (ELSA). Psychological distress was assessed with the General Health Questionnaire-12 (GHQ-12). Compared to never drinkers, moderate drinkers showed comparable scores on the ENRICA-GDS-10 (PRR (95%CI): 1.03 (0.84–1.26)), the ENRICA-GHQ-12 (0.88 (0.73–1.06)), the ELSA-CES-D (0.92 (0.79–1.06)) and the ELSA-GHQ-12 (0.75 (0.55–1.01). The MDP was not associated with the GDS-10 or GHQ-12 scores, or with clinically-diagnosed depression; however drinkers with a preference for wine showed an increased number of psychological distress symptoms (1.31 (1.03–1.66)). In conclusion, we found no consistent protective association between moderate alcohol consumption and depression in older adults.