Coalition on Substance Abuse & Older Vermonters

Alcohol & The Elderly

Less than half of alcoholics over 65 are diagnosed, a Penn State study has shown, because often the telltale signs of alcohol dependence are masked by patient denial and seeming good health.

Surveys of different age groups in the community 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 1920's, when alcohol use was stigmatized . In addition, some people increase their alcohol consumption later in life, often leading to late-onset alcoholism .

Surveys indicate that 6 to 11 percent of elderly patients admitted to hospitals exhibit symptoms of alcoholism, as do 20 percent of elderly patients in psychiatric wards and 14 percent of elderly patients in emergency rooms .

In acute-care hospitals, rates of alcohol-related admissions for the elderly are similar to those for heart attacks  . Yet hospital staff are significantly less likely to recognize alcoholism in an older patient than in a younger patient .

The prevalence of problem drinking in nursing homes is as high as 49 percent in some studies. The high prevalence of problem drinking in this setting may reflect a trend toward using nursing homes for short-term alcoholism rehabilitation stays . Late-onset alcohol problems also occur in some retirement communities, where drinking at social gatherings is often the norm .

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 to contribute to disease is unclear. Some examples of potential alcohol-aging interactions include the following:

• The incidence of hip fractures in the elderly increases with alcohol consumption . Studies of the general population suggest that moderate alcohol consumption (up to two drinks per day for men and one drink per day for women) may confer some protection from heart disease  Although research on this issue is limited, evidence shows that moderate drinking also has a protective effect among those older than 65 . 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-involved 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 starting at 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 .
• Long-term alcohol consumption activates enzymes that break down toxic substances, including alcohol. 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 .

Depressive disorders 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 a major depressive disorder than are those without alcoholism . In one survey, 30 percent of 5,600 elderly patients with alcoholism were found to have concurrent psychiatric disorders . Among persons older than 65, moderate and heavy drinkers are 16 times more likely than nondrinkers to die of suicide, which is commonly associated with depressive disorders .

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Does Aging Increase Sensitivity to Alcohol?

 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 metabolize 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).  Thus, an elderly person can experience the onset of alcohol problems even though his or her drinking pattern remains unchanged.

Aging, Alcohol, and the Brain

Aging and alcoholism produce similar deficits in intellectual (i.e., cognitive) and behavioral functioning. Alcoholism may accelerate normal aging or cause premature aging of the brain. Using magnetic resonance imaging techniques, researchers found more brain tissue loss in subjects with alcoholism than in those without alcoholism, even after their ages had been taken into account. The frontal lobes of the brain are especially vulnerable to long-term heavy drinking . Research shows that shrinkage of the frontal lobes increases with alcohol consumption and is associated with intellectual impairment in both older and younger subjects with alcoholism . In addition, older persons with alcoholism are less likely to recover from cognitive deficits during abstinence than are younger persons with alcoholism .

Age-related changes in volume also occur in the cerebellum, a part of the brain involved in regulating posture and balance . Thus, long-term alcohol misuse could accelerate the development of age-related balance problems,  increasing the likelihood of falls .

Treatment of Alcoholism in the Elderly

Studies indicate that elderly persons with alcohol problems are at least as likely as younger persons to benefit from alcoholism treatment. The outcomes are more favorable among persons with shorter histories of problem drinking (i.e., late onset). Additionally, although evidence is not entirely consistent, some studies suggest that treatment outcomes may be improved by treating older patients in age-segregated settings.

Because alcohol problems among older persons often are mistaken for other conditions associated with the aging process, alcohol abuse and alcoholism in this population may go undiagnosed and untreated or be treated inappropriately.

Health care providers should discuss alcohol use with their older patients as a part of routine care. Advice to older patients should include the medical conditions common to older people, such as high blood pressure and ulcers, that can be worsened by drinking and over-the-counter and prescription drugs that can be dangerous, or fatal, when mixed with alcohol. Where there is no medical condition that would preclude the use of alcohol, older patients should be advised to limit their alcohol intake to one drink per day.

Finally, health care providers, including emergency room personnel and admitting physicians who suspect an alcohol problem in their elderly patients, should refer such patients to treatment. 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.

Where to Find Help

AA in Vermont:

Call 1-800-253-0191     or

~Click here:  aavt.org

Vermont Recovery Network :

for Peer to Peer support and Recovery Coach support

~Click here: Vermont Recovery Network