Background: With the aging of the population, alcohol consumption among older adults presents a growing public health concern. Recognizing the prevalence and determinants of at- risk drinking among older adults is crucial for the development of effective interventions and improved healthcare outcomes.

Objectives: To estimate the prevalence of at-risk drinking and associated factors among older adults in primary care in Brazil.

Methods: A cross-sectional study with 1,639 participants aged 60 and above from fourteen primary care units in the city of the state of Sao Paulo, Brazil, between December 2023 and April 2024. At-risk drinkers were defined by the Alcohol Use Disorders Identification Test - Consumption (AUDIT-C scores ≥ 4), and/or binge drinking (≥ 3 drinks on a single occasion). Logistic regression was used to assess the association between sociodemographic characteristics, smoking, depression (PHQ-2 scores ≥ 3), and chronic diseases. A gender interaction test was conducted for all positive associations.

Results: The mean age of the 1,639 participants was 68.6 (SD ± 6,2; range: 60 –95), with 52.6% reporting current alcohol consumption, 21.3% were at-risk drinkers (AUDIT-C plus binge), and 26.8% regular smokers. Men (OR: 2,94; 95% CI: 2.21–3.90), those with high education (OR: 1.53; 95% CI: 1.10–2,14), were employed (OR: 1.50; 95% CI: 1.02-2.19), and current smokers (OR: 2.36; 95% CI: 1.73–3.23) were more likely to be at-risk drinkers. While older participants (70+) (OR: 0.96; 95% CI: 0.93–0,98), and those with depression (PHQ-2) (OR: 0.96; 95% CI: 0.93– 0.98) were less likely to be at-risk drinkers. Having a higher level of education was associated with a greater likelihood of at-risk drinking for men but not for women. Conversely, the presence of chronic diseases was associated with a reduced probability to be an at-risk drinker for women, but not formen.

Conclusions: This study revealed a significant prevalence of alcohol consumption, at-risk drinking, and binge drinking among older adults in primary care. Gender differences were observed in drinking behavior. These findings could aid health professionals in identifying at- risk drinkers and inform the development of targeted interventions for the most vulnerable groups.