Alcohol Use and Older Adults

Alcohol and Aging

Adults of any age can have problems with alcohol. In general, older adults don't drink as much as younger people, but they can still have trouble with drinking. As people get older, their bodies change. They can develop health problems or chronic diseases. They may take more medications than they used to. All of these changes can make alcohol use a problem for older adults.

What is Alcohol?

Alcohol is a chemical found in beverages like beer, wine, and "hard" liquor such as whiskey, vodka, and rum. In a process called fermentation, yeast converts the sugars naturally found in grains and grapes into the alcohol present in beer and wine. Another process, distillation, separates alcohol from the other substances in the drink and makes it stronger. That's the kind of alcohol found in hard liquor. The chemical name for alcohol is ethanol.

The National Survey on Drug Use and Health conducted in 2010 found that nearly 40 percent of adults age 65 and older drink alcohol. Most of them don't have a drinking problem, but some of them drink too much. Sometimes people don't know they have a drinking problem. Men are more likely than women to have problems with alcohol.

Older Adults are Sensitive to Alcohol's Effects

As people age, they may become more sensitive to alcohol's effects. One reason is that older people metabolize, or break down, alcohol more slowly than younger people. So, alcohol stays in their bodies longer. Also, the amount of water in the body goes down with age. As a result, older adults have a higher percentage of alcohol in their blood than younger people after drinking the same amount of alcohol.

Aging lowers the body's tolerance for alcohol. This means that older adults can experience the effects of alcohol, such as slurred speech and lack of coordination, more readily than when they were younger. An older person can develop problems with alcohol even though his or her drinking habits have not changed.

Drinking Can Cause or Worsen Health Problems

Drinking too much alcohol can cause health problems. Heavy drinking over time can damage the liver, the heart, and the brain. It can increase the risk of developing certain cancers and immune system disorders as well as damage muscles and bone.

Drinking too much alcohol can make some health conditions worse. These conditions include diabetes, high blood pressure, congestive heart failure, liver problems, and memory problems. Other health issues include mood disorders such as depression and anxiety. Adults with major depression are more likely than adults without major depression to have alcohol problems.

Alcohol and Medicines

Many older adults take medicines, including prescription drugs, over-the-counter (non-prescription) drugs, and herbal remedies. Drinking alcohol can cause certain medicines to not work properly and other medicines to become more dangerous or even deadly. Mixing alcohol and some medicines can cause sleepiness, confusion, or lack of coordination, which may lead to accidents and injuries. It also may cause nausea, vomiting, headaches, and other more serious health problems.

Some Medicines and Alcohol Don't Mix

Dozens of medicines interact with alcohol and can be harmful. Here are some examples.

Medications stay in the body for at least several hours. So, there can still be a problem if you drink alcohol hours after taking a pill. Read the labels on all medications and follow the directions. Some medication labels warn people not to drink alcohol when taking the medicine. Ask a doctor, pharmacist, or other health care provider whether it's okay to drink alcohol while taking a certain medicine.

How Alcohol Affects the Body

Drinking alcohol affects the body in many ways. These effects can lead to physical and mental changes that can put alcohol users and others at risk of injury or death. Possible dangers include falls, household accidents, and car crashes.

How Alcohol Moves Through the Body

When a person drinks beer, wine, or another alcoholic drink, the alcohol is quickly absorbed in the blood and then carried throughout the body. A drink of alcohol stays in the body for about 2 hours after being consumed. This period of time can vary depending on the person's weight, gender, and other factors. When a person drinks, the concentration of alcohol in the blood builds to a peak, then goes down. At first, alcohol often makes people feel relaxed and happy. Later, it can make them feel sleepy or confused.

The small intestine and the stomach absorb most of the alcohol after drinking. A small amount leaves the body through breath and urine. Eating food, especially fatty food, slows the absorption of alcohol. If people drink more alcohol than their bodies can absorb, they become drunk.

How Alcohol Affects the Liver, Brain, and Heart

Drinking too much alcohol affects many parts of the body. It can be especially harmful to the liver, the organ that metabolizes (breaks down) alcohol and other harmful substances. People who drink heavily for a long time can develop diseases such as liver inflammation (alcoholic hepatitis) or severe liver scarring (cirrhosis). Alcohol-related liver disease can cause death.

Alcohol not broken down by the liver goes to the rest of the body, including the brain. Alcohol can affect parts of the brain that control movement, speech, judgment, and memory. These effects lead to the familiar signs of drunkenness: difficulty walking, slurred speech, memory lapses, and impulsive behavior. Long-term heavy drinking can shrink the frontal lobes of the brain, which impairs thinking skills.

Drinking alcohol can affect the heart in good and bad ways. On one hand, studies have shown that moderate drinking -- up to two drinks a day for men and one drink for women -- can lower the chances of developing heart disease. On the other hand, heavy drinking -- either all at once or over time -- can damage the heart. Long-term alcohol use can also result in high blood pressure, which increases a person's risk of heart disease. However, blood pressure can go back to normal within a few months after drinking stops if there is not a lot of damage to the heart.

Male and Female Drinkers Compared

Alcohol affects men and women differently. In general, older men are more likely to drink alcohol compared with older women. But women of all ages are often more sensitive than men to the effects of alcohol. Women's bodies tend to break alcohol down more slowly. Also, women have less water in their bodies than men, so alcohol becomes more concentrated. As a result, women may become more impaired than men after drinking the same amount. That is why the recommended drinking limit for women is lower than for men.

Drinking for a long time is more likely to damage a woman's health than a man's health. Research suggests that as little as one drink per day can slightly raise the risk of breast cancers in some women, especially those who have been through menopause or have a family history of cancer. But it is not possible to predict how alcohol will affect the risk for cancer in any one woman.

How Alcohol Affects Safety

Even a Small Amount Can Be Dangerous

Drinking even a small amount of alcohol can lead to dangerous or even deadly situations. Drinking can impair a person's judgment, coordination, and reaction time. This increases the risk of falls, household accidents, and car crashes. Alcohol is a factor in 60 percent of fatal burn injuries, drownings, and homicides and in 40 percent of fatal motor vehicle crashes, suicides, and fatal falls. People who plan to drive, use machinery, or perform other activities that require attention, skill, or coordination should not drink.

Bad for the Bones

In older adults, too much alcohol can lead to balance problems and falls, which can result in hip or arm fractures and other injuries. Older people have thinner bones than younger people, so their bones break more easily. Studies show that the rate of hip fractures in older adults increases with alcohol use.

Drinking and Driving

Adults of all ages who drink and drive are at higher risk of traffic accidents and related problems than those who do not drink. Drinking slows reaction times and coordination and interferes with eye movement and information processing. People who drink just a moderate amount can have traffic accidents, possibly resulting in injury or death to themselves and others. Even without alcohol, the risk of crashes goes up starting at age 55. Also, older drivers tend to be more seriously hurt in crashes than younger drivers. Alcohol adds to these age-related risks.

In all states, it is against the law for people to drive if their blood alcohol concentration (BAC) is above a specific level. Blood alcohol concentration measures the percentage of ethanol -- the chemical name for alcohol -- in a person's blood. The higher the BAC, the more impaired a person is. The amount of alcohol consumed, gender, weight, and body fat all affect a person's BAC. A BAC below the legal limit can still impair driving skills. Some people are impaired even when they don't think they are. If you plan to drive, don't drink. If you drink, let someone else who has not been drinking do the driving.

Drinking and Relationships

Alcohol misuse and abuse can strain relationships with family members, friends, and others. At the extreme, heavy drinking can contribute to domestic violence and child abuse or neglect. Alcohol use is often involved when people become violent as well as when they are violently attacked. If you feel that alcohol is endangering you or someone else, call 911 or get other help right away.

If You Drink

Drinking Too Much Can Be Harmful

Millions of older adults drink alcoholic beverages. Some of them drink too much, which can harm their health and lead to safety problems. Sometimes it's hard to tell if someone has a drinking problem. Some signs of drinking, such as falls and depression, can be mistaken for other physical or mental conditions. Some people don't recognize or admit that they have a problem. Drinking problems are serious and should be treated by a doctor or other health care professional.

How Much Is Safe To Drink?

In general, healthy men and women over age 65 should not drink more than three drinks a day or a total of seven drinks a week. Drinking more than these amounts puts people at risk of serious alcohol problems. However, people can still have problems within these limits. Depending on their health and how alcohol affects them, older adults may need to drink less than these limits or not at all. Do not drink if you plan to drive a vehicle or operate machinery, take medicines that interact with alcohol, or have a medical condition that can be made worse by drinking.

How Can I Cut Back on My Drinking?

How much is one alcoholic drink? A "standard" drink contains about 0.6 fluid ounces of pure alcohol. A single drink can be

Not all drinks are served in standard sizes. For example, a mixed drink can contain as many as three or even more standard drinks, depending on the type of liquor and the recipe. Even popular brands of beer advertised as “light” may have almost as much alcohol as regular beer.

Weighing the Risks and Benefits of Drinking

Many people think that a little drinking can be good for you. Studies have shown that light to moderate drinkers -- men who have one or two drinks a day and women who have one-half or one drink a day-- are less likely to develop or die of heart disease than people who drink more or not at all. But it is not clear that red wine or any other alcoholic drink accounts for moderate drinkers' better health because they may be healthier than others to begin with. The risks of drinking must be considered along with the potential benefits. For example, as little as one drink a day can slightly raise the risk of breast cancer in some women, especially those who are past menopause or who have a family history of breast cancer. Doctors do NOT recommend that nondrinkers start drinking to improve their heart health.

How to Tell if Someone Drinks Too Much

It's not always obvious that someone drinks too much. For older adults, clues to a possible alcohol problem include memory loss, depression, anxiety, poor appetite, unexplained bruises, falls, sleeping problems, and inattention to cleanliness or appearance. Answering "yes" to at least one of the following questions is also a sign of a possible drinking problem.

If you answered "yes" to any of these questions, talk with your health care provider. Also seek help if you feel you are having drinking-related problems with your health, relationships, work, or the law.

Older adults drink for different reasons than do younger adults. Some have been drinking for many years and are physically dependent on alcohol. Others start drinking later in life because of health problems, boredom after retirement, or loneliness after the death of a spouse or close friend. This is called "late-onset drinking." Feeling tense or depressed can also trigger drinking.

Alcohol Abuse and Dependence

There are two main kinds of alcohol problems, alcohol abuse and alcohol dependence (also known as alcoholism). Alcohol abuse occurs when a person drinks too much and too often but is not physically dependent on alcohol. In addition to its physical effects, this abuse can lead to dangerous behavior such as driving a car after drinking, or to legal problems such as an arrest for drunk driving. Alcohol abuse can also involve trouble with personal relationships and with taking care of home or work responsibilities. People who abuse alcohol often continue to drink, even though they know it may cause these problems.

Alcohol dependence is a more serious problem than alcohol abuse. It is a lifelong disease in which people have a strong need to drink, cannot control their drinking once they start, and need to drink greater amounts of alcohol to get "high." Many, but not all, older adults with this disease physically depend on alcohol. When they stop drinking, they can get nauseated, sweaty, shaky, and restless. These withdrawal symptoms cause them to start drinking again, even though doing so can lead to physical or mental problems. Because of their increased sensitivity to alcohol, older people with alcohol dependence may not drink as much as younger people who are dependent on alcohol.

Does Alcohol Dependence Run in the Family?

Many factors can influence a person's risk of alcohol dependence. Some people inherit genes from a parent that increase the likelihood of alcohol dependence. Long-time heavy drinkers are more likely than late-onset drinkers to have a family history of alcohol dependence. High levels of stress, having friends and family members who drink, and ready access to alcoholic drinks also increase the chance of developing alcohol dependence. But, having an alcoholic parent does not always mean that a child will develop alcohol dependence. Some people become alcohol dependent even though no one in their family has a drinking problem.

Getting Help

People Can Be Treated Successfully

Most people with alcohol problems can be treated successfully. People who are alcohol dependent and those who abuse alcohol and cannot stay within healthy drinking limits should stop drinking altogether. Others can cut back until their drinking is under control. Changing drinking habits isn't easy. Often it takes more than one try to succeed. But people don't have to "go it alone." There are plenty of sources of help.

Treatment for Alcohol Problems

A doctor can help decide the best treatment for people with alcohol problems. Many people need more than one kind of treatment. Medicines can help alcohol-dependent people quit drinking. Meeting with a therapist or substance-abuse counselor or with a support group may also help. Support from family and friends is important, too. Making a change sooner rather than later makes treatment more likely to succeed.

Older people with alcohol problems respond to treatment as well as younger people. Some studies suggest that older adults do better when they are treated with other people the same age instead of mixed in with younger adults. Some communities have treatment programs and support groups specifically for older adults.

Medicines for Alcohol Dependence

Prescription medicines can help people who are alcohol dependent reduce their drinking, avoid going back to heavy drinking, and get sober. None of them works in every person. Naltrexone (Depade®, ReVia®, Vivitrol®) acts in the brain to reduce craving for alcohol. Acamprosate (Campral®) helps manage withdrawal symptoms such as anxiety, nausea, and sweating that may lead to a drinking relapse. Another medicine, disulfiram (Antabuse®), makes a person feel sick after drinking alcohol.

Support Groups Can Help

Many people with alcohol problems find it helpful to talk with others about their drinking. They can meet one on one or in groups with a therapist or counselor who specializes in substance abuse. They may also meet in self-help groups, such as Alcoholics Anonymous (AA). AA's "12-step" program helps people recover from alcohol dependence. AA meetings are open to anyone who wants to stop drinking. Attending self-help groups is beneficial for many people who want to stop drinking. Many people continue to go to support groups even after medical treatment for their alcohol problems ends.

To find help in your area, ask your doctor, local health department, or a local social service agency. You may also contact the following resources.

Some people with alcohol dependence are treated in a facility, such as a hospital, mental health center, or substance abuse clinic. Treatment may last as long as several weeks. This type of treatment typically involves detoxification (when a person is weaned from alcohol), medicine, and counseling.

Steps to Quit or Cut Back on Drinking

People with alcohol problems can take several steps on their own to help themselves. They can write down their reasons for cutting back or quitting, such as to avoid hangovers or improve relationships. They can write down a goal -- a limit on how many drinks they will have each day -- and put it somewhere easy to see. Then, they can keep track of drinking habits for a week to see if the goal was achieved. Other steps are to plan alcohol-free days each week and to drink water, juice, or soda instead of liquor.

There are some other actions that you can take to help change drinking habits:

Sticking With It

When treatment is successful, people have longer and longer periods without drinking alcohol. Finally, they are able to stop drinking or stick to healthy drinking limits. But treatment does not always work. Also, many people with alcohol problems do not even seek treatment. People with alcohol problems cannot be forced to get help, but family members and friends can support them when they are ready. For more information about dealing with alcohol problems, see www.rethinkingdrinking.niaaa.nih.gov.

Source: NIHSeniorHealth, NIH