Substance Use and Aging: Part One Alcohol
Alcohol is a substance people have consumed for millennia. Drinking as an adult is considered socially acceptable by many and studies indicate there may even be health benefits. Conversely, alcohol use may present increased health and safety risks as people age. Old habits, such as enjoying a drink or two in the evenings, may need to be revisited due to lowered alcohol tolerance.
Since a significant number of older people drink alcohol, it is both wise and prudent for health and service professionals to consider health and safety risks involved with alcohol use in later life.
Given the potential impact that alcohol may have, it is imperative to raise awareness about the possible dangers associated with alcohol use and misuse in later years.
How much is too much?
The Center for Disease Control and Prevention (CDC) provides the following sobering statement regarding the general use of alcohol:
“Drinking (alcohol) 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.”
Many older people and their family members may not be aware that physical changes associated with aging may alter the way alcohol affects an older person. Therefore, it is critical to provide essential information about potential risks. For example, inform people that it takes a smaller amount of alcohol for an older person to feel “tipsy” than someone who is younger due to metabolism and absorption changes. In addition, some older people admit using alcohol for psychosocial reasons such as “to calm the nerves” or dull physical or emotional pain (a.k.a., selfmedicating). This risky behavior may result in a medication mishap when alcohol is mixed with certain prescription (e.g. anti-anxiety) or over the counter drugs.
Scientists at Duke University have raised serious concerns that the number of older people who binge drink (more than 5 drinks at a single occasion) are more likely to drive impaired, placing themselves and the public at increased risk.
The National Institute on Alcohol Abuse and Alcoholism (NIAAA) recommends no more than one drink a day for both men and women that include 12 ounces of beer, five ounces of wine, or 1 ½ ounces of distilled spirits. Beyond that amount, older people may be engaging in risky drinking behavior or alcohol misuse that may result in serious physical, emotional, social and/or financial consequences.
Don’t mistake alcoholism for another condition – talk to your doctor
Health care and service professionals need to be aware that alcohol problems in older people may be mistaken for other conditions commonly associated with aging and may not be recognized, diagnosed and/or treated appropriately (e.g., dementia, depression) by providers. To enhance awareness and assist older people in making decisions about drinking, the NIAAA recommends that health care providers address alcohol issues by: Discussing alcohol use as a part of a routine interaction. Providing information about medical conditions common to older people, such as high blood pressure and ulcers that can be worsened by drinking. Advising that OTC and prescription drugs can be dangerous, or fatal, when mixed with alcohol. Encouraging them to limit their alcohol intake to one drink per day.
In addition, the NIAAA emphasizes the importance of referring an individual for treatment when suspecting that alcohol misuse is a problem. Popular screening tools include STMAST-G 10 and CAGE 11.
It may become necessary to address an older adult directly about drinking behaviors. Family members may be reluctant to confront their loved one and excuse misuse of alcohol with statements such as “He (or she) is old. Why take away his only pleasure? It’s too late.”
We believe professional responsibility includes ensuring that older people are given equal opportunity to experience a safe and healthy lifestyle. “It is a mistaken belief that older persons have little to gain from alcoholism treatment; each stage of life has its own rewards for sobriety, and they are all valuable.” It’s never too late.
Recommended Resource – Evelyn’s Pick
Helping Patients Who Drink Too Much: A Clinician’s Guide and Related Professional Resources, National Institute of Alcohol Abuse and Alcoholism.
GERO GEMS is a monthly publication of the Center for Aging with Dignity. Compiled by Evelyn Fitzwater, this publication is designed to raise awareness of aging and related issues impacting health care professionals and our society as a whole.
For more information:
Go to the Senior Health health topic.