Late-Onset Alcoholism

A number of years ago I wrote an article about the impact of drinking on older adults. Everyone got nervous about the topic because there is something about happy hour and social drinking that is prevalent in our culture. This was for a newsletter for a group of homes for independent-living adults. The article was never published in that newsletter. Because people get anxious about the topic of drinking and alcoholism, I have been reluctant to write about it. Substance abuse among seniors over the age of 60, particularly alcohol and prescription drugs, has become a serious problem throughout this pandemic. I thought it was time to educate everyone about this being one of the fastest growing health problems in the United States.

The Facts About Senior Alcohol Abuse

According to the Office of Alcoholism and Substance Abuse Services, substance abuse among seniors can be classified into two general forms: the ‘hardy survivor’ – those who have been abusing substances for many years and have reached 65, and the ‘late-onset’ group – they formed their addictions later on in life.

A study by the American Medical Association states that over the past 10 years, drinking has increased in every age group, but those over the age of 65 had the greatest rise of any age group.

While adults over the age of 65 remained less likely to drink than younger people, they still showed a 22% increase between 2001 – 2013. This was the greatest rise in any age group. Alcohol Use Disorders – also known as alcoholism – more than doubled in a decade, plaguing over 3% of older people, or about 2.5 million seniors. Researchers reported that the number of older adults engaging in “high-risk drinking” increased by 65, defining high-risk drinkers as a man consuming five or more standard drinks in a day at least weekly during the past year; or, for a woman, downing four such drinks in a day.

Causes of Addiction in Seniors

Potential triggers or causes for drug or alcohol addiction in seniors include:

· Retirement

· Death of a family member, spouse, pet, or close friend

· Loss of income or financial status

· Relocation or placement in a nursing home

· Trouble sleeping

· Family conflict

· Mental or physical decline (depression, memory loss, major surgeries, etc.)

The Dangers of Alcohol/Substance Abuse in Older Adults

Individuals over the age of 65 have a decreased ability to metabolize drugs or alcohol, along with an increased brain sensitivity to them. Major dangers of untreated alcohol abuse include:

· Alcohol contributes to 60% of falls.

• Older adults lose dexterity and flexibility and may have balance problems. This problem only gets worse after having a few drinks. Falls are the culprit in over 2.8 million emergency room visits each year. Even though they may be non-fatal they can impede senior’s mobility.

· Increased Sensitivity

• Typically, as we age our tolerance for alcohol decreases as our metabolism slows down. As we age our body’s water content is reduced, which means the same amount of alcohol consumption gives a higher blood alcohol level.

· Increased Health Problems

• Alcohol abuse can cause health problems and make existing problems worse. Alcohol can cause or worsen conditions such as these:

§ Liver diseases such as cirrhosis

§ Diabetes

§ Osteoporosis

§ High blood pressure

§ Memory problems

§ Congestive heart failure

§ Mood disorders (such as depression)

· Reactions to medications

• Because seniors take more medications than younger age groups, the risk of a reaction goes up too.

• Here are a few common medications that react badly with alcohol:

§ Pain medication

§ Heart medicines

§ High blood pressure treatments

§ Diabetes medications such as insulin

§ Antibiotics

§ Cough syrups

§ Cold medicines

§ Acetaminophen and aspirin

§ Sleeping pills

§ Anxiety and depression medications

§ Heartburn medicine

Alcohol and the Aging Brain

With normal aging, the brain begins to shrink in middle-age, losing volume in the frontal lobes, and the hippocampus, which leads to a decline in cognitive function and memory as people grow older. It is widely understood that alcohol misuse over time can have harmful effects on brain structure and function. Research has revealed that adults with Alcohol Use Disorder had brain volume reductions, independent of sex, in a number of areas, including the frontal, temporal, parietal, cingulate and insular cortices. These affects were particularly evident in adults age 65 and older. Accelerated aging was evident in some brain areas, including the frontal cortex. It should be noted that the accelerated aging was also seen in participants who had developed Alcohol Use Disorder in later life.

These findings provide evidence that alcohol misuse during later adulthood could confer a greater risk of deficits in frontal lobe function beyond the deficits that normally occur with aging.

Concerns for Older Drinkers

It is important to remember that aging introduces a wide range of concerns for people who drink alcohol.

Aging slows down the body’s ability to break down alcohol, so it remains in a person’s system longer.

Because alcohol may act differently in older people than in younger people, some older adults can feel increased effects from the same amount of alcohol they drank when they were younger. This increases the risks of accidents, fractures and falls occurring.

Many medicines, including prescription, over the counter, or herbal remedies – can be dangerous, even deadly when mixed with alcohol.

And, as mentioned earlier, alcohol can complicate other health problems.

This could be the cruelest of concerns for older adults who drink alcohol. Socializing with other people is a healthy brain practice. Connecting with other people can increase cognitive skills. But the mere practice of getting together with friends, lends itself to the practice of social drinking. Even though research hasn’t determined whether moderate drinking (1 drink/day/women, 2 drinks/day/men) is risk free or not, being cognizant of the risks of drinking alcohol when you are older, must always be a consideration on how ‘social’ you might be.

Update on Pandemic Drinking in Older Adults

Studies on older adult drinking prior to the pandemic indicated that alcohol use in older adults has been trending upward over the years, particularly among women. One survey determined that in the United States between 2001 and 2013, among people 65 and older, the rate of alcohol use disorder increased 107%. The University of Michigan’s 2021 National Poll on Healthy Aging found that although most older adults surveyed were drinking alcohol at low to moderate levels, there was a subset of older adults exceeding the recommended guidelines for alcohol use. 20% of respondents drank alcohol four or more times per week; 27% reported having six or more drinks on at least one occasion in the past year; and 7% reported alcohol-related blackouts. This report indicated that there was another group of older adults who drink use other drugs while drinking, including marijuana or prescription medications that can interact with alcohol in risky ways.

Emerging evidence indicates that individuals in the US and globally are increasing their alcohol use in response to the COVID-19 pandemic. Research that has examined older adults’ alcohol use during the early phases of the pandemic has generally found that compared to younger adults, older adults report smaller increases in alcohol use. However, a national survey study and a study of social media users both found that older adults reporting depression and anxiety symptoms during the pandemic were more likely to increase their alcohol use than those without these symptoms.

(Sugarman, D. Greenfield, S. Rising Alcohol Use Among Older Adults)

The pandemic has had a long reach in the impact on health among older adults. We would be doing a disservice to those we love who have increased their alcohol consumption to not say anything to them. There are services available to help us get through this sub-crisis.

References:

Addiction Center. Senior Citizens and Substance Abuse. Retrieved from https://www.addictioncenter.com/addiction/elderly

Alcohol Addiction Center. Six Facts about Elderly Alcohol Abuse. Retrieved from https://alcoholaddictioncenter.org/elder-alcohol-abuse/

Dotinga, R. Alcohol may not be kind to the aging brain. Retrieved from https://www.mwdicinenet.com/script/main/art.asp?articlekey=160367

Gavin, K. (June 09, 2021). Poll finds risky drinking patterns in older adults during pandemic. Retrieved from https://healthblog.ufomhealth.org/wellness-prevention/poll-finds-risky-drinking-patterns-older-adults-during-pandemic

Jefferson, R.S. (January 25, 2019). As problem drinking rises in older Americans, geriatrician offers tips for those who imbibe over 65. Retrieved from https://www.forbes.com/sites/robinseatonjefferson/2019/01/25/as-problem-drinking-rises-in-older-americans-geriatrician-offers-tips-for-those-who-imbibe-over-65/#

NIAAA. (September 13, 2018). Alcohol and the aging brain. Retrieved from https://www.printfriendly.com/p/g/UbHS32

Sugarman, D.Ph. & Greenfield, S. MD, MPH (September 24,2021). Rising alcohol use among older adults. Retrieved from https://www.health.harvard.edu/blog/rising-alcohol-use-among-older-adults-2021109242599