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Alcohol Use Disorder in Older Adults: Spot the Warning Signs

“Dad has always enjoyed a drink after work. Now that he’s retired, he’s got a lot more time on his hands.”

Unfortunately, it’s not uncommon for advancing age and alcohol use disorder to walk hand-in-hand. It can be hard to see the symptoms in your loved one, and just as hard for them to see in themselves. The physical and mental decline that comes with aging can sometimes look like inebriation. So, how do you tell the difference? And if there is a problem, how do you bring it up?

Krista LaBruzzo, MD, an addiction medicine fellow at Banner - University Medical Center Phoenix, told us about how alcohol affects seniors differently than non-seniors, how to determine if there’s a problem, and the misconceptions surrounding this important topic.

Alcohol and the aging body

According to the National Institute of Health (NIH), drinking too much alcohol over a long time can have the following effects:

  • Increased risk for some types of cancer, liver damage, immune system disorders and brain damage.
  • Worsened health conditions like osteoporosis, diabetes, high blood pressure, stroke, ulcers, memory loss and mood disorders.
  • Increased difficulty finding and treating medical problems related to the heart and blood vessels.
  • Increased forgetfulness and confusion, which can be mistaken for Alzheimer’s disease.

Across all ages, alcohol can disrupt the immune system, which can cause more infection, organ damage and slower injury recovery. The older we get, our risk for these effects increases.

As we age, Dr. LaBruzzo explained, several things happen that directly change our alcohol metabolism. The first is that we begin having lower water volume. So when we drink alcohol, the alcohol’s blood concentration increases, simply because the alcohol has less water to dilute it.

Second, aging livers have fewer enzymes to break down alcohol. And since our liver is the main organ for this task, our body’s alcohol concentration is likely to be higher as we age, even with the same amount of alcohol.

“What this boils down to is that we are much more sensitive to the effects of alcohol than when we were younger,” Dr. LaBruzzo summarized.

In her experience, the most common consequence of alcohol use/abuse in seniors is falls, which can cause painful bruises, breaks and fractures. The NIH estimates that in 60% of falls, alcohol is a factor.

Medicine, alcohol and aging: a tricky cocktail

Whether they’re prescription, over the counter or herbal, many medicines can be dangerous or deadly when mixed with alcohol. Some examples:

  • Aspirin with alcohol increases your risk of stomach or intestinal bleeding.
  • Alcohol used with large doses of acetaminophen (a common painkiller) can cause liver damage.
  • Some medicines, like cough syrups and laxatives, have high alcohol content. If you consume them while you drink alcohol, your alcohol level will increase.
  • Using alcohol with some sleeping pills, pain pills or anxiety/anti-depression meds can be deadly.

Since older people often take more medications as they age, this risk can be quite serious. Dr. LaBruzzo mentioned the Beers Criteria, a list of potentially dangerous medications for older adults. Although the Beers Criteria isn’t specific to the interaction of medication and alcohol, it’s still important here because of how alcohol can intensify a medication’s side effects. Regardless of age, it is always important to discuss potential medication interactions and side effects with you doctor or pharmacist.

How to bring it up

Because symptoms of alcohol abuse can look so similar to symptoms common with aging, it’s easy for the warning signs to go unrecognized. Dr. LaBruzzo estimated that 1-6% of older adults have an alcohol use disorder, and up to 30% of hospitalized elderly patients in a hospital’s general medicine unit have an alcohol use disorder.

Older adults also face more social isolation and loneliness. In this state, they may self-medicate with alcohol.

“The biggest misconception is thinking it’s rare for older adults to have an alcohol use disorder,” Dr. LaBruzzo said. “It is common, and we should be asking more questions.”

So how should we ask questions? Dr. LaBruzzo said the best approach is to simply be curious, and ask questions in a non-judgmental way. Your loved one likely doesn’t see the problem or is more interested in denying it. A gentle approach will produce the best results when broaching the topic. The standard recommendation, she said, is for people 65 and older to drink no more than one standard drink per day or seven standard drinks per week.

Getting the help you need

If you are concerned about an aging person in your life, have these conversations sooner rather than later. If you or a loved one needs help managing your relationship with alcohol, schedule a visit with a Banner behavioral health specialist by visiting bannerhealth.com or calling 800-254-4357.

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