Healthy Aging Column – the Hidden Epidemic: Alcohol Abuse by Aging Americans

People of all ages can abuse alcohol. Even though use and abuse of alcohol by young people under age 21 is a problem often seen in the news, studies show that one out of seven Americans over 65 is an alcoholic.

In 1996, The Council on Scientific Affairs of the American Medical Association reported that one out of every 10 older patients admitted to hospitals exhibited symptoms of alcoholism. In  psychiatric wards, one in five patients over 65 years old is an alcoholic. In a 1993 article in the Journal of the American Medical Association, Adams, Yuan and Barboriak reported that in acute-care hospitals, the rate of alcohol-related admissions is similar to rates for heart attacks.

One out of three drinkers over age 65 is a situational alcohol abuser who began drinking when the hardships of aging became overwhelming. Retirement, loss of income, failing health, loss of a partner, depression or trouble sleeping can trigger situational alcohol abuse. In 1989, Curtis, Geller and Stokes reported in the Journal of the American Geriatric Society that hospital staff are less likely to recognize alcoholism in older patients than in younger patients.

Alcohol abuse by older people is not recognized for a variety of reasons. Alcoholism and problem drinking can create symptoms including:

– changes in sleeping including sleep apnea,

– confusion or disorientation,

– changes in eating patterns including malnutrition,

– poor hygiene,

– slurred speech,

– incontinence,

– tremors,

– shakiness, and

– frequent falls or bruising.

These symptoms can be mistaken for other conditions, leaving alcoholism and problem drinking undiagnosed or untreated. In addition, medical professionals may not ask the right questions to identify the part alcohol plays in an older person’s life. Families may be in denial or not around the aging person enough to recognize the signs of alcohol abuse.

Quantities of alcohol that may have been moderate when the person was younger can cause problems as a person ages. The National Institute on Alcohol Abuse and Alcoholism defines moderate alcohol consumption for people over 65 as no more than one drink per day for men and not more than a half-drink per day for women. A drink is defined as 12 grams of alcohol, which is the equivalent of 12 ounces of beer, 5 ounces of wine or 1 ounce of 80-proof distilled liquor.

The effects of alcohol are exaggerated as people age. Because body water volume decreases when the percentage of muscle and bone mass decreases with aging, blood alcohol levels in older people are 30 percent to 40 percent higher than in younger people who consume the same type and amount of alcohol. Aging also results in a decline in the stomach enzyme, alcohol dehydrogenase, which breaks down alcohol before it reaches the bloodstream. This lower level of stomach enzyme, combined with decreased liver and kidney function, means that alcohol is eliminated more slowly from the blood stream, leading to higher blood alcohol levels. Older women are at added risk because of smaller size and naturally lower levels of alcohol dehydrogenase and may become more intoxicated than a man from the same size drink.

Other effects of increased alcohol consumption include shrinkage of the frontal lobe of the brain that leads to intellectual impairment. Alcohol also results in reduced volume of the cerebellum, the part of the brain that regulates posture and balance, which could make older people more prone to falls. Emerging research by Dr. Mila Kivipelto of Sweden has shown that drinking alcohol, even infrequently, may increase risk of dementia for the estimated one out of five people with the apoE4 gene.

Another risk that older adults should take into consideration is the interaction between prescribed and over-the-counter medications and alcohol. The most common medications that can interact negatively with alcohol are acetaminophen, antidepressants, aspirin, other non-steroidal anti-inflammatory drugs, diabetes medications and sleep aids. These negative alcohol and drug interactions can lead to gastrointestinal bleeding, a three-times-greater risk for depression and anxiety, cognitive impairment and poor balance that can lead to falls and subsequent fractures.

People need to seek help if they are:

– using alcohol to calm nerves, forget worries, reduce depression or aid in sleeping;

– losing interest in food;

– hiding their drinking from others;

– hurting themselves or others while drinking;

– becoming visibly intoxicated three or more times in a year;

– acting irritable, resentful or unreasonable when not drinking or after a certain hour of the day;

– causing medical, social or financial problems by use of alcohol; and/or

– starting off the day with a drink.

Two separate studies from the mid-1990s found elderly people with alcohol problems are as likely as younger people to benefit from alcoholism treatment. People with shorter histories of alcohol abuse are more likely to be successful. According to Atkinson in Alcohol and the Aging (1995), success seems to be more likely if they are in age-segregated treatment settings.

For more information, support organizations and resources include National Institute on Alcoholism and Alcohol Abuse at and Elderly Use and Abuse of Alcohol and Drugs Interest Group of the Gerontological Society of America at

Additional Healthy Aging articles are available at the Colorado State University Cooperative Extension Web site at by going to Family and Consumer and then selecting Healthy Aging.

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by Janet Benavente, Family and Consumer Science Extension Agent

Colorado State University Cooperative Extension, Adams County