Alcohol and Alcoholism Among the Aging and Elderly
Persons age 65 and older constitute the fastest growing segment of
the American population. Although the extent of alcoholism among the
elderly is debated, the diagnosis and treatment of alcohol problems are
likely to become increasingly important as the elderly population grows.
Drinking Prevalence and Patterns Among the Elderly
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.
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. 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 (i.e., myocardial infarction). Yet
hospital staff members 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, depending in part on survey methods. 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.
Comparison among studies is complicated by the diversity of the
subject population: The "elderly" span more than four decades
in age and range from the actively employed to the disabled and
institutionalized. Consequently, different studies employ different
definitions of the term. In addition, surveys of alcohol consumption
among the elderly are subject to potential sources of error for some of
the following reasons:
- Questionnaires customarily used to screen for alcoholism may be
inappropriate for the elderly, who may not exhibit the social,
legal, and occupational consequences of alcohol misuse generally
used to diagnose problem drinkers.
- Alcohol-related consequences of heavy drinking can be mistaken for
medical or psychiatric conditions common among the elderly. Such
consequences may include depression, insomnia, poor nutrition,
congestive heart failure, and frequent falls.
- Because alcohol-related illnesses are a major cause of premature
death, excess mortality among heavy drinkers may leave a surviving
older population who consume less alcohol.
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-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. 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
nondrinkers 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 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). Through a decreased ability to
develop tolerance, elderly subjects persist in exhibiting certain
effects of alcohol (e.g., incoordination) at lower doses than 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.
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