Seniors face unique challenges when it comes to alcohol consumption
By the time we reach our senior years, we hope that a lifetime of sound health habits, including eating right, exercising, routine physicals and taking medications as prescribed by our doctors, will be rewarded with the opportunity to finally ease back a bit and enjoy retirement, extra time with friends and family, hobbies and travel. This added social time might mean dining out more as well as extra time to enjoy a fine wine, a cocktail or a beer.
A social drink or two is one thing. But the cautions that held true throughout our younger years about avoiding excessive drinking become particularly important to heed as we move on through the twilight years.
We spoke to KelseyCare Advantage Medical Director Donnie Aga, M.D. to get a better understanding of the health risks to seniors associated with alcohol consumption.
“While excessive alcohol use at any age isn’t healthy, older people are at an especially increased risk of damaging their health if they drink too much,” explains Dr. Aga. “There are complex medical and sociological factors unique to seniors that contribute to this problem, including the fact that alcohol abuse in the elderly appears to be underdiagnosed, and thus undertreated.”
The Scope of the Problem
In a 2008 survey, the National Institute on Alcohol Abuse and Alcoholism (NIAAA) found that about 40 percent of adults ages 65 and older admit to drinking alcohol. However, one study of a large seniors’ community put the number at 62 percent who drink, with 13 percent of men and two percent of women engaging in “heavy drinking,” defined as two or more drinks a day. [Sally K. Rigler, M.D Alcoholism in the Elderly University of Kansas School of Medicine, Kansas City, Kansas American Family Physician. 2000 Mar 15;61(6):1710-1716.]
Alcohol and Aging
People respond to alcohol differently as they age, which can lead to additional health issues. “You lose lean muscle mass as you age, which increases your sensitivity to alcohol,” explains Dr. Aga. “The effects of alcohol happen more quickly, and that can put you at a higher risk for debilitating accidents like serious falls and car crashes.”
Another problem is the interaction between medications and alcohol. “The older you get, the more likely you are to be on multiple medications,” Dr. Aga points out. “There are prescription medications, over-the-counter medications and even some herbal remedies that can be dangerous if mixed with alcohol. If you drink, find out if any of your medications or supplements fall into that category, and be open and honest with your doctor about all your medications and drinking habits.”
The NIAAA recommends that adults over age 65 who are healthy and do not take medications should limit their alcohol intake to a total of seven drinks in a week. This includes not having more than three drinks on any given day.
Undiagnosed Alcoholism and Other Complicating Factors
As with any medical problem, alcoholism cannot be treated if it isn’t diagnosed. As far back as 1988, the NIAAA published a report of current research that indicated that alcoholism in the elderly is underdiagnosed. Later research from Penn State in 2003 also indicates that less than half of alcoholics over 65 are diagnosed. [Pringle, K.; Shea, D. “Triangulation in Action: Prevalence and Risk Factors for Alcoholism Among Elderly Medicare Beneficiaries.” Academy Health annual meeting in Nashville, Tenn., Friday, June 27, 2003]
So, why is this the case? “There are many factors at work here,” explains Dr. Aga. “First, many of the symptoms of alcohol abuse that would be red flags in younger people – such as memory loss, cognitive impairment, musculoskeletal pain, loss of libido – are easily attributed to old age. Doctors might miss the connection if they don’t ask about alcohol use.”
Secondly, most of the questionnaire tools used to diagnose alcohol abuse are designed for younger people. “For example, a common question is, ‘How often have you overslept or missed work due to alcohol use?’” says Dr. Aga. “Well, if you are retired and can sleep as long as you want, this line of questioning is not helpful in determining if alcohol is a problem with an older person.”
Lastly, older people may be at an increased risk of alcoholism because of complex life changes that often happen as they age and retire. “Among seniors, the risks of social isolation and depression are real,” says Dr. Aga. “Work and social obligations change, often decreasing. Relatives and friends start dying off. Health issues may prevent frequent travel to see children or other family members. Depression and other mood disorders can be the cause of alcohol abuse, but they can also be the effects of alcohol abuse, creating a vicious cycle.”
Not All Alchohol is Harmful
Concerns about the potentially harmful effects of alcohol on seniors are not necessarily a reason to avoid alcohol altogether. Studies show there can be a positive side to drinking when it comes to the “bad” cholesterol in your body. Known as low-density lipoprotein or LDL levels, this is the cholesterol that leaves fatty deposits in the arteries and can lead to a heart attack or stroke.
“Although moderate alcohol consumption doesn’t actually lower cholesterol levels, it does help raise the ‘good’ HDL cholesterol (high density lipoprotein) which helps clear excessive cholesterol from the body,” explains Dr. Aga. Many studies consider moderate drinking to be one drink daily for women and one to two daily drinks for men. For red wine drinkers, there is an added bonus called resveratrol. Found in the skin of red grapes, this is shown to help prevent blood clots by reducing plaque and LDL cholesterol.
Dr. Aga advises seniors to be cautious. “Over-drinking may eliminate any positive health gains made through moderate alcohol consumption. If you are a non-drinker, don’t start drinking just to attain the health benefits. Remember, exercise and a cholesterol wise diet can also produce positive results.”
For those who do consume excessive amounts of alcohol, successful treatments are available, regardless of age. In fact, studies show that older people with a drinking problem may be more likely to complete a course of therapy than a younger drinker. [Atkinson, R. Alcohol problems of the elderly. Alcohol & Alcoholism 22(4):415-417, 1987. Kofoed, L.; Tolson, R.; Atkinson, R.; Toth, R.; and Turner, J. Treatment compliance of older alcoholics: An elder-specific approach is superior to "mainstreaming." Journal of Studies on Alcohol 48(1):47-51, 1987. Williams, M. Alcohol and the elderly: An overview. Alcohol Health & Research World 8(3(:3-9, 52, 1984.]
“If you think you have a drinking problem, you should definitely have an open and honest discussion with your doctor,” encourages Dr. Aga. “Medicare offers screenings for alcohol and substance abuse at with no copayment for beneficiaries, so there is nothing to lose.” To schedule a screening, contact the Kelsey-Seybold Contact Center at 713-442-0000.
Dr. Aga acknowledges that people abuse alcohol for many different reasons. “Discovering those reasons and dealing with them – whether they are physical or emotional – are important steps on the path to enjoying a healthier way of living,” he says.