This fact sheet covers screening and identification, diagnosis and management strategies of alcohol misuse and dependence in older adults.

This article was written for family physicians and gives an overview of epidemiology, pharmacology of alcohol and aging, adverse effects of excessive alcohol use, identifying alcohol problems in older adults, clinical management and treatment options.

These guidelines are largely based on the issues raised during the European Association for the Study of Liver monothematic conference on Alcoholic Liver Disease in 2010. The guidelines have three main aims: (1) to provide physicians with clinical recommendations; (2) to emphasize the fact that alcohol can cause several liver diseases (steatosis, steatohepatitis, cirrhosis), all of which may coexist in the same patient; (3) to identify areas of interest for future research, including clinical trials.

Case based article: My neighbor Joe was rarely without a hip flask during Prohibition, and, while a hip flask eventually went out of vogue, he didn't change his drinking habits as he aged. Joe was a functioning alcoholic – he, and everyone who knew him, was well aware of that fact. He was also brilliant, inventive and funny. He had reached 87 years, and had no desire to quit drinking. His wife had died a few years before, and, as his neighbor, I'd become his primary caregiver. His one son lived half-way across the country.

This article describes alcohol use and abuse by elder parents, when to seek help, and what type of treatment options are available.

As people age, they naturally become more sensitive to the effects of alcohol. Older adults are not able to absorb alcohol at the rate they once did which causes the alcohol to stay in their bodies longer. An older adult drinking the same amount as a younger adult will have a higher percentage of alcohol in their body.(4) The combination of these effects lowers the body’s tolerance for alcohol.

Why is it important?

  • An older adult can develop alcohol-related problems even when drinking habits remained the same (4)
  • Heavy drinking can damage the liver, heart, brain, muscle and bone
  • Heavy drinking can increase risk of cancers and immune disorders (4)
  • Drinking can make existing health conditions worse: diabetes, memory problems, high blood pressure, congestive heart failure, mood disorders and osteoporosis (4)

Common Causes

  • Major life changes (e.g. death of a loved one, moving to a new home, failing health, poverty) can cause loneliness,boredom, anxiety, or depression (3)
  • Older adults faced with large amounts of free time after retirement may turn to alcohol (5)

Key Considerations

  • Read labels on all medications and follow the directions as some medication labels warn not to drink alcohol when taking medicine; ask your health care provider or pharmacist whether it's okay to drink alcohol while taking a specific medicine (4)
  • Discuss concerns with health care provider; ask for referral to support group or counseling service
  • Set limits for yourself, eat before and while drinking, always consider your age, weight and health problems
  • Older adults should never exceed Canada’s Low-Risk Alcohol Drinking Guidelines: 2 drinks per day or 10 drinks per week for women; 3 drinks per day or 15 drinks per week for men (2)
  • Although drinking may provide health benefits for certain people, it is not recommended to start drinking to increase health benefits (1)

References

1.      Canadian Centre on Substance Abuse. (2013). Canada’s Low-Risk Alcohol Drinking Guidelines. 
         Retrieved March 5, 2014 from:
         http://www.ccsa.ca/Resource%20Library/2012-Canada-Low-Risk-Alcohol-Drinking-Guidelines-Brochure-en.pdf

2.      Canadian Centre on Substance Abuse. (2012). Canada’s Low-Risk Alcohol Drinking Guidelines: 
         Frequently Asked Questions. Retrieved March 5, 2014 from:
         http://www.sbir-diba.ca/docs/default-document-library/2012-faqs-canada-low-risk-alcohol-drinking-guidelines

3.      National Institute on Aging.  (2014). Alcohol Use in Older People. Retrieved March 5, 2014 from: 
         http://www.nia.nih.gov/health/publication/alcohol-use-older-people

4.      NIH. (2012). Alcohol Use and Older Adults. Retrieved March 5, 2014 from: 
         http://nihseniorhealth.gov/alcoholuse/alcoholandaging/01.html

5.      PHAC. (2010). The Chief Public Health Officer’s Report on The State of Public Health in Canada 2010.
         Retrieved March 5, 2014 from:
         http://www.phac-aspc.gc.ca/cphorsphc-respcacsp/2010/fr-rc/cphorsphc-respcacsp-06-eng.php

Additional Resources

1.      Seeking Solutions Project.  (2004) BEST PRACTICES:  alcohol and other substance use withdrawal
         Retrieved March 2014 from:
         http://www.agingincanada.ca/BEST_7.PDF

2.      Seeking Solutions Project.  (2004) BEST PRACTICES:  using harm reduction.  Retrieved March 2014 from: 
         http://www.agingincanada.ca/Best_3.pdf

As people age, they naturally become more sensitive to the effects of alcohol. Older adults are not able to absorb alcohol at the rate they once did which causes the alcohol to stay in their bodies longer. An older adult drinking the same amount as a younger adult will have a higher percentage of alcohol in their body. (3) The combination of these effects lowers the body’s tolerance for alcohol.

Why is it important?

  • An older adult can develop alcohol-related problems even when drinking habits remained the same (3)
  • Heavy drinking can damage the liver, heart, brain, muscle and bone
  • Heavy drinking can increase risk of cancers and immune disorders (3)
  • Drinking can make existing health conditions worse: diabetes, memory problems, high blood pressure, congestive heart failure, mood disorders and osteoporosis (3)

Common Causes

  • Major life changes (e.g. death of a loved one, moving to a new home, failing health, poverty) can cause loneliness, boredom, anxiety, or depression (2)
  • Older adults faced with large amounts of free time after retirement may turn to alcohol (4)