Drinking prevalence and patterns among the elderly

Drinking prevalence and patterns among the elderly

Surveys of different age groups in suggest that the elderly, generally defined as persons older than 65, consume less alcohol and have fewer alcohol-related problems than younger persons. However, some surveys that track individuals over time suggest that a person’s drinking pattern remains relatively stable with age, perhaps reflecting societal norms that prevailed when the person began drinking.

For example, persons born after World War II may show a higher prevalence of alcohol problems than persons born in the 1920s, when alcohol use was stigmatised. In addition, some people increase their alcohol consumption later in life, often leading to late-onset alcoholism.



Aging and elderly alcoholism growing worse

In contrast to most studies of the general population, surveys conducted in health-care settings have found increasing prevalence of alcoholism among the older population. In acute-care hospitals, rates of alcohol-related admissions for the elderly are similar to those for heart attacks. Yet hospital staff members are significantly less likely to recognise alcoholism in an older patient than in a younger patient.




Combined effects of alcohol and aging

Although many medical and other problems are associated with both aging and alcohol misuse, the extent to which these two factors may interact is unclear. Some examples of potential alcohol-aging interactions include the following:
• The incidence of hip fractures in the elderly increases with alcohol consumption. This increase can be explained by falls while intoxicated combined with a more pronounced decrease in bone density in elderly persons with alcoholism compared with elderly non-alcoholics.
• Because of age-related body changes in both men and women, NIAAA recommends that persons older than 65 consume no more than one drink per day.
• Alcohol-related traffic crashes are an important cause of trauma and death in all age groups. The elderly are the fastest-growing segment of the driving population. A person’s crash risk per mile increases from age 55, exceeding that of a young, beginning driver by age 80. In addition, older drivers tend to be more seriously injured than younger drivers in crashes of equivalent magnitude. Age may interact with alcoholism to increase driving risk. For example, an elderly driver with alcoholism is more impaired than an elderly driver without alcoholism after consuming an equivalent dose of alcohol, and has a greater risk of a crash.
• Long-term alcohol consumption activates enzymes that break down toxic substances, including alcohol. Upon activation, these enzymes may also break down some common prescription medications. The average person older than 65 takes two to seven prescription medications daily. Alcohol-medication interactions are especially common among the elderly, increasing the risk of negative health effects and potentially influencing the effectiveness of the medications.
• Symptoms of depression are more common among the elderly than among younger people and tend to co-occur with alcohol misuse. Data from the National Longitudinal Alcohol Epidemiologic Survey demonstrate that, among persons older than 65, those with alcoholism are approximately three times more likely to exhibit such symptoms than are those without alcoholism. Among persons older than 65, moderate and heavy drinkers are 16 times more likely than non-drinkers to die of suicide.




Aging increases sensitivity to alcohol

Limited research suggests that sensitivity to alcohol’s health effects may increase with age. One reason is that the elderly achieve a higher blood alcohol concentration (BAC) than younger people after consuming an equal amount of alcohol. The higher BAC results from an age-related decrease in the amount of body water in which to dilute the alcohol. Therefore, although they can metabolise and eliminate alcohol as efficiently as younger persons, the elderly are at increased risk for intoxication and adverse effects. Aging also interferes with the body’s ability to adapt to the presence of alcohol (i.e., tolerance). Through a decreased ability to develop tolerance, elderly subjects persist in exhibiting certain effects of alcohol (e.g., incoordination) at lower doses than do younger subjects whose tolerance increases with increased consumption. Thus, an elderly person can experience the onset of alcohol problems even though his or her drinking pattern remains unchanged. These conclusions are supported by laboratory experiments with rats that indicate age-related changes in tolerance to alcohol.