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A Fine Vintage? Alcohol and Older People
A report published this week by Slimming World looks at the impact of alcohol on obesity. Just as in other ages groups, alcohol may contribute to obesity in older people, but are there also other concerns around alcohol intake in this population?
Are older people drinking too much?
Drinking a small amount of alcohol poses no significant risk to health and may actually offer some benefit. However, there is growing concern about the amount of people who are drinking in excess of the recommended limits. Drinking too much alcohol can contribute to a number of health problems ranging from liver damage to stroke and obesity.
There are currently no alcohol limits set specifically for older people except that for the general population. Men shouldn’t regularly drink more than 3 to 4 units per day and women shouldn’t regularly drink more than 2 to 3 units per day. Older people though have been shown to have poorer knowledge of alcohol units, and survey data suggests that 1.4 million older people, or 20% of men and 10% of women aged 65 and over, exceed government alcohol intake limits. There has in fact been a steady increase in the amount of alcohol consumed by older people in recent years. Furthermore, since the number of older people is increasing, even in the event that the prevalence of excessive alcohol consumption drinking remains the same, the absolute number of people drinking too much alcohol will increase.
Is excess alcohol more harmful in the older person?
It may be surprising that whilst the spotlight on excessive drinking generally falls on younger people, the most significant increases in alcohol-related harm are actually in older age groups. Despite lower total levels of alcohol intake, people aged 65 and over drink more often over the entire course of a week, and are more likely to be admitted to hospital or die from an alcohol-related problem than younger groups. Older people account for more than half a million alcohol-related admissions each year. The number of deaths from alcohol-related causes amongst people aged 75 and over increased by 58% in the last 20 years, and the number of alcohol-related illnesses and mental health disorders among older people are also on the rise. Excessive alcohol use in older people is associated with a plethora of adverse consequences including falls and accidents, insomnia, incontinence, gastrointestinal problems, dementia, Parkinson’s disease, memory loss, self-neglect, depression and suicide.
Decreased social activity, divorce, isolation and loneliness can be a major contributory factor to excessive alcohol intake in the older person. Some older people develop an alcohol problem for the first time in later-life and their drinking is often related to life stresses such as retirement or bereavement. Others may look at alcohol as ‘medicinal’ for relieving illnesses and pains, but this may instead foster a dependence on alcohol. In contrast, ‘early-onset’ drinkers have a continued problem with alcohol developed in earlier life. Late-onset drinkers are more receptive to treatment and more likely to recover spontaneously from an alcohol problem than early-onset drinkers.
Physical changes of ageing and alcohol tolerance
Physiological changes in older people may make them less tolerant to alcohol , with the same amount of alcohol producing a higher blood alcohol concentration, and more vulnerable to alcohol-related harm. These changes include:-
- Reduced activity of the enzyme alcohol dehydrogenase, which breaks down alcohol.
- Poor kidney and liver function.
- Greater depression of brain function, impairing memory and raising the likelihood of hypothermia, injury by accident and self –neglect.
- Greater susceptibility to lack of balance, increasing risk for falls.
As people age they are more likely to have chronic illnesses, be on medications, or have functional impairments. Prescribed medication, taken in conjunction with alcohol, can cause adverse effects; this may diminish the drug’s impact or increase the body’s sensitivity to it. For example, drugs which act on the central nervous system like diazepam can depress the rate of alcohol breakdown exaggerating the effects of alcohol. Alcohol taken with certain antidepressants may worsen the depression. Alcohol can also reduce the effect of warfarin, which can increase the risk of bleeding or developing a clot.
What are the health risks?
Regularly drinking more than the recommended daily limits increase many health risks like:-
- liver cirrhosis and liver failure: increase risk of developing liver cirrhosis by 3 to 10 times;
- cancer of the mouth, stomach and liver: increase risk of getting cancer of the mouth, neck and throat by 3 to 5 times. Women are around 1.5 times as likely to get breast cancer;
- high blood pressure and stroke. Men could have four times the risk of having high blood pressure, and women are at least twice as likely to develop it.
For those older adults that drink in excess, ensuring adequate nutrition is important. Alcohol contributes to malnutrition by replacing foods needed for essential nutrients and by interfering with absorption, storage or metabolism of the essential nutrients. Whilst alcohol provides calories, it does not provide the carbohydrates, protein, fat, vitamins or minerals needed to maintain body functions. Alcohol's effect on the gastrointestinal tract also promotes poor nutrition. Malabsorption, the poor absorption of food nutrients, may be a problem. Alcohol can also irritate the gut wall, leading to inflammation and ulceration.
More recognition needed amongst health and social professionals
Alcohol problems in older people frequently remain undiagnosed. This may make it more likely for them to receive medical management for the health problems caused by alcohol use, rather than treatment for the alcohol problem itself. The symptoms of alcohol problems in older people are not specific and therefore difficult to distinguish from the symptoms caused by the medical or psychiatric problems of ageing. In addition, older people may be reluctant to reveal alcohol problems and cognitive decline and memory impairment may make self-reports less reliable. Furthermore, there may be lack of awareness amongst professionals that alcohol misuse is a potentially important problem for older people or a reluctance to ask embarrassing questions of older people. Research suggests that health and social care workers frequently take the view that older people are too old to learn something new, particularly when this requires a change in behaviour, or that they do not want to deprive them of the ‘last pleasures’ in their lives.
Although there is evidence of an emerging growth of alcohol problems amongst older people, media attention revolves around young people, binge drinking and antisocial behaviour. Alcohol problems amongst older people are largely overlooked or ignored, yet research has demonstrated that older people can be successfully treated for alcohol problems, and that you can, despite the view of some health and social professionals ‘teach an old dog new tricks.’
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