Hidden Plague of Alcohol Abuse by the Elderly
By: Jane E. Brody
New York Times, April 2, 2002
Alcohol abuse by seniors: experts call it a hidden
epidemic. Hidden because its symptoms often mimic or are masked by common
physical and mental infirmities of aging. Hidden because doctors rarely
ask about when and how much their older patients drink or what effect
alcohol may have on their lives.
Hidden because older people and their relatives are
often in denial about the extent and effects of their drinking habits.
Hidden because the amount of alcohol now causing trouble had no untoward
social or physical effects in middle age. Hidden because many of the
hallmarks of excessive drinking — like missing work or being noticeably
intoxicated — may not be noticed among retirees who live alone.
Although problem drinking is less common over all
among older people, as the population ages, increasing numbers of older
adults are getting into trouble with alcohol, often with an amount of
alcohol that most would not consider immoderate. In some cases, even
moderate consumption can cause or aggravate ailments associated with aging
or cause dangerous interactions with medicines older people take.
While few would deny a healthy older person a glass
of wine or that cocktail before dinner, the nation's experts on alcohol
are now urging greater restraint for drinkers over 65 and asking people in
and out of the medical field to pay more attention to the drinking habits
of older adults.
On April 11, National Alcohol Screening Day,
thousands of people at 2,000 sites across the country will have a chance
to have their drinking patterns assessed anonymously and the findings
discussed with trained counselors.
To find the nearest screening site, call (800)
405-9200 or, on the Web, consult mentalhealthscreening.org. Screening is
urged even if alcohol is not a problem for you but may be for someone you
care about.
An older person may have never had a previous alcohol
problem, but various circumstances common among older people can increase
the risk of alcohol abuse. Retirement may result in a loss of structure,
self-esteem and income and an increase in loneliness and boredom. Other
losses — of spouses, friends, physical well-being or independence — as
well as pain or sleep problems may also prompt older people to turn to
alcohol.
Changing Effects of Alcohol
Because the body that is consuming alcohol at 65 or
beyond is not the same as the one that drank at 45, the effects of a given
amount of alcohol can be greatly exaggerated in an older person.
As people age, they lose lean body mass (muscle and
bone) and acquire a greater percentage of body fat. This results in a
decrease in body water, and since alcohol is soluble in water, not fat, a
given amount of alcohol reaches higher concentrations in the blood of an
older person.
In addition, as people age, there is a decline in a
stomach enzyme — alcohol dehydrogenase — that starts to break down
alcohol before it reaches the bloodstream. This further increases the
blood alcohol level and places an extra burden on the liver, where most
alcohol metabolism takes place. Furthermore, with advancing age, blood
flow through the liver declines as does kidney function, so alcohol is
eliminated more slowly from the blood.
Older women are especially at risk because they are
usually smaller, have less lean body mass and lower levels of alcohol
dehydrogenase than men, all factors that result in a higher blood alcohol
levels than men experience. In fact, at any age women reach higher levels
of intoxication than men do per dose of alcohol.
All told, blood alcohol levels in older people
typically are 30 percent to 40 percent higher than in younger people who
consume the same amount of alcohol. But even at equivalent blood alcohol
levels, older people are more likely than the middle aged to experience
intoxication, cognitive difficulties and problems with balance and
coordination. In other words, tolerance for alcohol declines, and the
risks of excessive drinking rise with age.
Add to this the interactions between alcohol and some
150 prescription and over-the-counter medications, and you have the
potential for disaster resulting from immoderate alcohol intake by older
people, most of whom take drugs for conditions like arthritis, depression,
hypertension and heart disease. Among the common drugs that can interact
badly with alcohol are acetaminophen, antidepressants, aspirin and other
nonsteroidal anti-inflammatory drugs, digoxin, heparin, hypoglycemics and
sleep aids.
Certain ailments common among older people can be
worsened by alcohol, among them gastrointestinal bleeding, depression and
anxiety, cognitive impairment, cirrhosis and other liver diseases,
hypertension and cardiac arrhythmias, osteoporosis and impaired immunity.
And while many people believe that alcohol before bed
aids their sleep, in fact, alcohol interferes with normal deep sleep and
commonly results in middle-of-the-night insomnia.
Be aware, too, that reflexes slow with advancing age,
a problem greatly worsened by alcohol for anyone who tries to drive soon
after drinking even a small amount.
Many people who live into their 90's and beyond
attribute their longevity in part to their daily cocktail or glass of
wine.
Though this may sound like an attempt to justify a
bad habit, in fact studies of tens of thousands of people here and abroad
have found that regular moderate alcohol intake diminishes the risk of
heart disease and possibly stroke, probably by raising blood levels of
protective H.D.L. cholesterol and estrogenic substances.
Moderate alcohol consumption has also been linked to
a reduced risk of dementia in people over 55. The key word here is
moderate. For younger adults, moderate is defined as no more than two
drinks a day for men and no more than one drink a day for women.
But for healthy men and women over 65, the new
definition of moderate offered by the National Institute on Alcohol Abuse
and Alcoholism is no more than one drink a day, and some experts suggest
that older women would be wise to cut that amount in half.
Defining a Drink
A study in the mid-1990's revealed that 15 percent of
men and 12 percent of women 60 and older visiting a primary care clinic
regularly drank more than one drink a day. Depending on the group studied,
2 percent to 10 percent of older adults have been found to abuse alcohol.
What is "a drink"? It is 12 grams of pure
alcohol, the amount found in a 12-ounce beer, a 5-ounce glass of wine or a
shot of 80-proof distilled liquor.
In ordering a drink, the amount of alcohol served may
be considerably more than "one drink." You would be wise to
measure out the specified amount of your favored beverage at home so you
can recognize when you are served far more than the recommended amount.
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