Factors Associated with Alcohol Consumption Behavior among Older Adults in Northeastern Thailand

Abstract

Nowaday, Thailand has officially entered a fully aged society, with over 20 percent of the population aged 60 years and older. This demographic transition has significantly affected the health system and social policies, particularly regarding the health and quality of life of older adults. Among the complex and challenging health issues in this population, alcohol consumption stands out as a critical concern. Age-related physiological changes make older adults more vulnerable to the adverse effects of alcohol, resulting in a wide range of health complications-physical,mental, and social. This problem is especially pronounced in Northeastern Thailand,where cultural traditions are closely intertwined with alcohol use. Alcoholic beverages are integral to local rituals, festivals, and community gatherings, making drinking behavior a socially accepted norm.

The present study aimed to determine the prevalence of current alcohol consumption and to examine factors associated with drinking behavior among older adults in Northeastern Thailand, considering multiple dimensions including socioeconomic factors, health status and health behavior, health service accessibility, and social participation. This analytical cross-sectional study utilized secondary data from the 2024 Survey of Older Persons in Thailand conducted by the National Statistical Office. The study sample consisted of 14,629 adults aged 60 years and older residing across Northeastern provinces. Descriptive statistics were used to describe the general characteristics of the participants and to estimate the prevalence of current alcohol consumption. The generalized linear Mixed Model (GLMM) was employed to analyze the association between independent variables and alcohol consumption behavior while accounting for clustering effects at the provincial level. Results were presented as adjusted odds ratios (AOR)with 95% confidence intervals (95% CI).

The findings revealed that 19.73 percent of older adults reported current alcohol drinking. Significant factors associated with drinking behavior included socioeconomic variables such as male gender (AOR=9.21; 95%CI: 8.08–11.51), younger-old adults aged below 69 years (AOR=4.79; 95%CI: 3.53–6.49), current employment status (AOR=2.02; 95%CI:1.79–2.29), and annual income equal to or exceeding 100,000 THB (AOR=1.25; 95%CI:1.10–1.41). Health-related and behavioral factors also showed significant associations, including the absence of chronic diseases (AOR=1.28; 95%CI: 1.14–1.43) and smoking behavior(AOR=7.79; 95%CI: 6.74–9.00). Regarding social participation, membership in local occupational groups (AOR=1.49; 95%CI: 1.24–1.80), participation in volunteer groups(AOR=1.64; 95%CI: 1.37–1.96), and engagement in major village or community events (AOR=1.54; 95%CI: 1.33–1.80) were all positively associated with alcohol consumption.These findings suggest that alcohol drinking among older adults is not merely an individual behavior but rather a social and cultural phenomenon shaped by community norms that encourage alcohol use as part of social engagement. Consequently, abstaining from alcohol can be socially challenging within the Northeastern cultural context.

The study underscores the necessity of developing culturally sensitive health promotion strategies that respect and incorporate local traditions. This includes establishing “healthy community leader” models and empowering village health volunteers to provide culturally appropriate alcohol-related counseling. Moreover, promoting health literacy through local-language communication is essential to correct misconceptions about traditional alcohol consumption, such as the belief that homemade spirits are beneficial to health. Public health policies should therefore focus on mitigating risk factors, creating supportive social environments that promote healthy aging, and encouraging older adults to participate in creative and meaningful social activities that are alcohol-free. A comprehensive and sustainable approach is required to reduce alcohol use among older adults while preserving the cultural identity of Northeastern communities. Such strategies will not only improve health outcomes and quality of life for older adults but also strengthen the cultural and social fabric that supports community well-being in Thailand’s aging society. Therefore, the development of policies and intervention measures to address alcohol consumption among older adults should emphasize integrated actions across multiple levels, including the individual, family, community, and health service system levels.Proactive policies should prioritize systematic risk screening within primary health care services,the provision of brief interventions for older adults at risk, and continuous follow-up through multidisciplinary health care teams. At the same time, capacity building among village health volunteers and older adult caregivers should be strengthened to enhance their skills in motivational communication and in providing culturally appropriate guidance on alcohol reduction. These frontline personnel play a critical role in bridging formal health services and community-based support, particularly in rural and culturally diverse settings. In addition, communities should be encouraged to develop alternative alcohol-free social activities, such as health promotion programs, recreational activities, and volunteer initiatives, to provide meaningful social engagement without reliance on alcohol. Such approaches can gradually reshape social norms related to drinking among older adults and reduce the social pressure to consume alcohol during community gatherings and traditional events. Collectively, these strategies will contribute to a sustainable reduction in alcohol consumption among older adults, while simultaneously promoting active aging, strengthening social support systems, and enhancing overall quality of life in the long term. By adopting an integrated and culturally sensitive policy framework, public health systems can more effectively respond to the complex social and health determinants that influence alcohol use in later life.

Keywords: Alcohol drinking behavior, Northeastern Thailand, Older adults

Author Contributions
AN: Conceptualization, Method and design, Tool development and validation, Data collection,analysis and interpretation, drafting, reviewing, and editing the manuscript, Final approval of the submitted version
NP : Conceptualization, Method and design, Tool development and validation, Analysis and interpretation, drafting, reviewing, and editing the manuscript, and Final approval of the submitted version, Responding to the editor
KS : Tool development and validation, Data interpretation
PS : Tool development and validation, Analysis and interpretation
SG : Tool development and validation, Analysis and interpretation
WP: Provision of feedback on tools development and validation.
JY : Conceptualization, Method and design, Provision of feedback on tools development and validation, Research supervision, Data analysis and interpretation, Drafting, reviewing,and editing the manuscript.