Alcohol and Aging

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. This Alcohol Alert reviews recent research on the extent of alcohol consumption and associated problems among the elderly, updating an earlier Alcohol Alert on this subject.

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.

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.

Does Aging Increase 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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