ALCOHOL ABUSE AMONGST THE ELDERLY: A COMPLETE GUIDE
Alcohol is a major part of the culture of the United States. In 2014, alcohol sales—which include beer, wine, liquor, and other alcoholic beverages—totaled nearly $225 billion. The following year, more than 15 million Americans over the age of 18 reported having Alcohol Use Disorder (AUD), known more commonly as alcoholism. That number reaches even higher among people who haven’t reported the disease or have yet to see a doctor for a diagnosis.
Of People Don't Start to Drink Heavily Until They are Older in Age
A number of people in that group are seniors. About 10 to 15 percent of people don’t start to drink heavily until they are older in age, according to UCLA professor Dr. Alison Moore. Because of this, alcohol-related emergency room discharges among the elderly reached nearly a three-quarters of a million in 2012. This number—as well as the number of alcoholics who are also seniors—is expected to rise as the senior population reaches grows to 80 million by the year 2050.
To first understand the severity of alcohol addiction among the elderly, though, we must first understand what an alcohol addiction is and can look like.
What Is An Addiction?
Addiction is defined by the American Psychiatric Association as “a brain disease that is manifested by compulsive substance use despite harmful consequence.” It is an illness, just like cancer and heart disease are, and not something people prolong to do as a “choice.” Those who suffer from addiction often continue to participate in whatever substance they’re addicted to when they know it is detrimental to their health and life, and when they’re aware of treatment options. It is nearly impossible for them to stop on their own and without help.
The National Institute on Drug Abuse noted a number of reasons why people start drinking or using drugs:
For pleasure (it makes them feel good)
Because of peer pressure
Out of curiosity of what drugs or alcohol makes you feel like
To stay attentive while working, studying, or being around other people
To make them feel better or less stressed
Even When Seniors Live Inside Nursing Homes & Assisted Living, the NCADD says that nearly 50% Have "Alcohol-Related Problems."
Alcohol-related emergency room discharges among the elderly reached nearly a three-quarters of a million in 2012.
Once users start to consume more drugs and/or alcohol, they build up a tolerance to the substance, and it takes more and more to reach the desired effect. This amount varies per person.
In 2014, the Substance Abuse and Mental Health Services Administration said there were approximately 21.5 million people aged 12 or older in the United States addicted to either alcohol or drugs. Nearly three million of those suffer from addictions to both of those substances.
Not everyone who is addicted to a substance shows it. You may often hear people close to addicts who overdose or seek treatment say things like, “I never in a million years would’ve guessed he/she was addicted to alcohol,” or, “I knew they liked to drink, but I never knew it was that bad.”
Addiction can come in all shapes, sizes, and amounts. There are people who could be high or drunk and continue to function in their public and working lives but become secluded and distant in their private lives. The opposite remains true, too, as those addicted to a substance can have their public and working life destroyed by substance abuse, and it could severely impact their performance at work.
Just as there are different reasons why people start consuming alcohol or drugs, there is a wide range of symptoms—both physical and mental—that may reveal an addiction. These symptoms may be in plain sight, but they can also be hidden away, because they’re only partaking in their addiction in solitude. Some of these symptoms include:
Short term memory loss
Sudden fluctuations in weight
Becoming isolated from family and friends
Making an excuse as to why you’re drinking (or doing a certain drug), like you’re stressed or you’ve had a long day
Start to change social groups, toward people who may be addicts and are encouraging and reinforcing the behavior
A change to a lethargic behavior, which also may signal depression
Bruises or cuts on the skin, specifically where drugs may be injected into the bloodstream
These symptoms can appear in people at any age.
Prevalence Among Seniors
Alcoholism doesn’t stop once you hit a certain age. While it may sound easy to chalk up an alcoholic’s tendencies to “he’s lived a long life already and earned the right to make his own decisions,” there is no specific age where it’s okay for you to be consuming mass amounts of alcohol.
The National Council on Alcohol and Drug Dependence points out that up to 11 percent of elderly hospital admissions are because of drug- and alcohol-related issues. This is a similar rate to elderly people being admitted to the hospital because of heart attacks, which can also be caused by prolonged alcoholism. The alcohol-related admissions number increases to 14 percent relating to emergency room visitations, and the rate at which the elderly are admitted to psychiatric hospitals due to alcohol or drugs is 20 percent.
- 11% of Elderly Hospital Admissions are Because of Drug- and Alcohol-Related Issues 11%
- 14% of Alcohol-Related Admissions are Emergency Room Visits 14%
- 20% Is the Rate at Which the Elderly are Admitted to Psychiatric Hospitals Due to Alcohol or Drugs 20%
To make matters more difficult, studies have found that older people are less likely to receive alcoholism as an out-of-the-gate diagnosis than younger people. This problem can boil down to how difficult it is to identify alcoholism in a senior. One study conducted in the late 1980s found that it was less likely that older patients (who are alcoholics) would be diagnosed with alcoholism than younger patients with alcoholism would be.
One article, which describes substance abuse among seniors as an “invisible epidemic,” notes that a driving force behind alcoholism and substance abuse in the elderly is how many live independently, or not in nursing homes or assisted living. Less than 5 percent of seniors live in dependent living situations, which allows a great deal of potential isolation and independent decision making to percolate into a substance addiction.
Even when seniors live inside nursing homes and assisted living, though, the NCADD says that nearly 50 percent of those living in those facilities have “alcohol-related problems.” The same council also points out that the demographic with the highest rates of alcoholism are widowers (men who have lost their spouse) over the age of 75.
Increased Sensitivity to Alcohol
Aging can lower the body’s tolerance for alcohol. Older adults generally experience the effects of alcohol more quickly than when they were younger. This puts older adults at higher risks for falls, car crashes, and other unintentional injuries that may result from drinking. “Even though younger and older adults appear to have similar metabolism, the behavioral implications are different,” said Sara Jo Nixon, a researcher and professor at the University of Florida.
There are a number of physiological reasons as to why older adults start to feel the effects from alcohol quicker. These reasons can include:
Less Muscle to Absorb Alcohol
When alcohol makes its way through the body—first being partially being absorbed through the stomach in the gastrointestinal tract, then distributed through the bloodstream—it absorbs much quicker into muscle than it does fat. As you age, you lose muscle, and it’s replaced by fat. Therefore, when you’re drinking alcohol, there is more of it flowing through your bloodstream. This results in you feeling its effects for longer periods of time as the alcohol waits to be completely absorbed. This also results in a higher blood alcohol concentration (BAC) level, which is an indicator of how intoxicated you are.
Alcohol Takes Longer to Absorb
Not only do you have less muscle to absorb the alcohol more quickly, your body simply takes longer to digest it. This can cause serious damage to vital organs, and also prevent medications you may be taking from working properly.
Less Water in Our Body
In our youth, water makes up about 70 percent of our bodies. Between the ages of 20 and 80, though, that amount decreases by about 15 percent. Less water is retained as kidney function decreases, too. This is why dehydration is such a big issue among seniors. Alcohol contributes to dehydration, so when paired with less water in the body in the first place, it can create a damaging combo for seniors.
In addition to feeling the effects of alcohol quicker, the damage alcohol can do to older bodies proliferates as we age when it is paired with health issues that already are more problematic in the elderly.
Increased Health Problems
Drinking alcohol throughout your life can cause a slew of health issues, particularly when you abuse it as you age. Let’s look into how years of alcohol abuse can exacerbate the risk of many health issues that you are already at risk of contracting simply due to age.
Diabetes is a condition where the body has a resistance to insulin—the hormone your body uses to break down sugar for energy. Some are born with the condition or develop it at a young age, where the body simply doesn’t produce the insulin needed to break down the sugar (type 1). However, others develop the condition over time as your body builds up a resistance to the insulin your body produces. This is type 2 diabetes, and it is the most common form of diabetes. Some symptoms of type 2 diabetes include:
- Fatigue and general tiredness
- Having to urinate more (often because you’re frequently more thirsty)
- Blurred vision
- Cuts and wounds healing slower
Alcohol abuse can contribute to the proliferation of type 2 diabetes. A site that helps sift through the health issues that stem from heavy drinking points out some ways that drinking can increase your chance of developing type 2 diabetes:
Alcohol itself can make the body less sensitive to insulin, as one study points out, which is the primary cause of type 2 diabetes. The study found that the more subjects drank, the less glucose was metabolized and stayed in the bloodstream, which can cause damage to all of your organs.
Alcohol also stops the liver from breaking down and releasing sugar as it is busy breaking down the alcohol you consumed. A long history of this can have long-lasting damage on your liver. This also results in higher blood glucose levels throughout your body, which is a leading cause of type 2 diabetes.
The pancreas creates the insulin your body needs to break down sugar. Alcohol abuse can lead to damaging and inflaming the pancreas (pancreatitis), which can then result in diabetes as your pancreas doesn’t produce enough insulin to keep up with the levels of sugar in your blood.
The caloric intake from drinking can contribute to obesity, which is another leading cause of type 2 diabetes. In fact, there is a direct correlation in higher waist sizes and the chance of having diabetes.
Not only can alcohol abuse increase the risk of developing type 2 diabetes, once diagnosed, it’s recommended that you seldom drink or don’t drink at all, which can be a tough regimen to follow when someone is addicted to it. It’s suggested people with type 2 diabetes have no more than one to two drinks during a session of drinking. If effects from the diabetes have already started to show—like blindness and hypertension—it’s suggested that you don’t drink at all.
High Blood Pressure. Drinking can have immediate and long-term effects on your blood pressure levels, according to the American Heart Association. Having more than two to three drinks can increase your blood pressure and cause acute heart attacks, strokes, and blurred vision—all potentially lethal consequences for seniors. Over time, alcohol abuse can steadily increase your overall blood pressure levels, even when you’re not drinking. Some effects of high blood pressure include:
Kidney Failure: High blood pressure damages arteries in the kidneys that are used to filter blood.
Heart Attacks and Strokes: Arteries and veins leading to your heart can be damaged, strained, and blocked over time due to high blood pressure
Decreased Libido: Erectile dysfunction can be a consequence in men with high blood pressure, while women can experience a decreased sexual libido.
Heart Failure: As blood pressure increases, the heart has to work overtime to make sure blood flows through the body properly, which can ultimately result in heart failure.
If you’re suffering from high blood pressure due to an addiction to alcohol, it’s suggested you slowly decrease how much you drink per day. Quitting alcohol cold turkey can cause increased blood pressure levels over the span of a couple days, enough so to result in fatal consequences.
Congestive Heart Failure. As discussed in the previous section, high blood pressure can eventually lead to heart failure. But there are other factors associated with heavy drinking that can also lead to congestive heart failure. According to the American Heart Association, heart failure happens when “the heart muscle is weakened and cannot pump enough blood to meet the body’s needs for blood and oxygen.” Some of the main causes of heart failure include:
- Type 2 diabetes
- Myocardial infarction
All of these conditions are increased with the presence of heavy drinking, which then in turn increases the risk of heart failure. Alcohol abuse can also result in alcoholic cardiomyopathy, which is described as having damaged parts of the heart among patients with a long-term history (five to 15 years) of heavy alcohol consumption. Alcoholic cardiomyopathy, too, is a large risk factor in heart failure.
It’s possible to qualm or reverse the effects of drinking. In the case of alcoholic cardiomyopathy, it’s been shown that abstinence from alcohol can reduce the risk of cardiac death.
Liver Problems. After years of alcohol abuse, your liver can stop working. This is a progressive process, however, and it doesn’t just all of a sudden stop functioning one day. The liver’s main function is to regulate what is in your blood, from the glucose to the protein. As we’ve discussed in the diabetes section, alcohol can stop your liver from filtering glucose as it breaks down the alcohol, resulting in long-term damage to the arteries in your liver and all over your body. In this process of breaking down alcohol, the body also produces bad material that can damage the liver even more. Years of abuse can create scar tissue all over the liver, which can ultimately render it unusable.
The two main phases of liver disease are:
Alcoholic Fatty Liver Disease: The primary stage of liver disease. It often occurs in people who are heavy drinkers and are obese.
Alcoholic Liver Cirrhosis: Up to 20 percent of alcoholics develop this disease. It can result in internal bleeding, jaundice, and ascites, and you may eventually need a liver transplant to stay alive.
If you start to abuse alcohol in your elderly years, these conditions can culminate very quickly, because there may have been previous damage to your liver.
Osteoporosis is a disease that causes the gradual thinning and weakening of bone. It is one of the most common diseases in America, with more than 50 million people having the disease or at high risk of having it, according to the National Institute on Health. Having a low bone mass can cause you to have easily breakable bones. This, in turn, can call for more trips to the hospital and longer stays as bones heal and rehab, which can then cause increased rates of mortality.
Alcohol abuse can cause bones to wither and contribute to the proliferation of osteoporosis. The NIH says that heavy drinking can affect the body’s calcium levels, which are important to maintaining strong bones. It can also mess with hormone levels in both men and women. Certain hormones that men (testosterone) and women (estrogen) produce assist in maintaining strong bones through the production of osteoblasts and other bone-supporting cells. Alcohol can negatively affect the levels of testosterone and estrogen in men and women, thus affecting the strength of bone in the body.
Memory Problems. In the present activity of drinking, older people may reach the point of memory loss (blackout, spotty short-term memory) quicker than they used to, because of their increased sensitivity to alcohol. Whereas it may have taken hours of heavy drinking to reach that point in the past, it may now only take a couple drinks.
Over the long term, years of alcohol abuse have been found to have debilitating effects on the brain, from motor functions down to what you can remember. One study found that middle-aged men who averaged two and a half alcoholic beverages per day were more likely to experience “more rapid mental losses” over the next decade than men who drank less frequently than that. The study also concluded that heavy drinkers started to experience memory loss one-and-a-half to six years earlier than those who drank less.
The National Institute of Alcohol Abuse and Alcoholism says that about 80 percent of alcoholics have deficiencies in thiamine (vitamin B), which can result in memory and psychosis issues, including Wernicke–Korsakoff syndrome. This syndrome is actually a set of two separate disorders: Wernicke’s encephalopathy and Korsakoff’s psychosis. These are common disorders among older alcoholics.
Wernicke’s encephalopathy’s main symptoms include:
- Eye paralysis
- Problems with muscle coordination
Patients with WE may never exhibit any of these symptoms, which is why it is often diagnosed after a patient has passed. WE can also occur in flashes, and you may only exhibit one or two of the symptoms throughout your life and are left undiagnosed. Around 80 to 90 percent of those with WE, the NIAAA says, also develop Korsakoff’s psychosis, which is a more chronic syndrome that severely affects memory and motor functions.
Mood Disorders. Alcohol and substance addiction can result in mood disorders like depression and bipolar disorder over an extended period of abuse, according to one study. It’s important for doctors to clarify, though, if patients were suffering from the mood disorder before the addiction onset, or if the mood disorder is a result of years of abuse.
The NIAAA notes that, while mood disorders and alcoholism can co-exist and not be caused by one another, patients with mood disorders “are more likely to have difficulty maintaining abstinence, to attempt or commit suicide, and to utilize mental health services” than alcoholics who don’t have or didn’t develop mood disorders.
Dehydration is a major issue among the elderly population. In one study, up to 30 percent of seniors who were hospitalized also were suffering from dehydration. As discussed earlier, one of the large reason why seniors are more sensitive to alcohol is because elderly people have less water in their bodies. Drinking alcohol—especially in excess over a long period of time—only makes matters worse.
You become dehydrated when you drink alcohol because our bodies re-absorb less water than it would with no alcohol in our system. There is also the consequence of vomiting while drinking alcohol, which can further dehydrate us of necessary fluids and electrolytes. Being dehydrated is especially risky when you are a senior.
Dehydration can cause:
- Kidney issues
- Brain swelling
While dehydration is often reversible with proper care, the constant strain placed on the body by dehydration can result in dire consequences in the long-term.
Bad Interactions with Medications
Many prescription and over-the-counter medications, as well as herbal remedies, can be dangerous or even deadly when mixed with alcohol. According to the NIAAA, medications that can interact badly with alcohol include:
Drinking too much alcohol while also taking aspirin—a pain reliever—can result in internal bleeding and liver damage, as both alcohol and aspirin put significant strain on the stomach and liver.
Like aspirin, drinking while also taking an acetaminophen like Tylenol or Nyquil can cause liver and kidney problems. While one instance of drinking and taking Tylenol will not result in significant issues, people who drink regularly need to pay particular attention when when taking acetaminophens as there has already been damage to your liver.
Cold and Allergy Medicine
Drinking alcohol while also taking cold and allergy medicine (the ones that don’t have acetaminophen, as discussed before) can make you feel drowsy—even more than the alcohol already does.
Taking cough syrup, which is scientifically named dextromethorphan, already has adverse effects, in addition to causing drowsiness and difficulty concentrating, so drinking alcohol along with it can exacerbate these issues.
Alcohol already makes you feel drowsy, so drinking along with it can make the side effects, which include confusion, diarrhea, and impaired motor skills, even worse. There is also the potential of causing you to stop breathing while sleeping.
Anxiety or Depression Medicine
Taking anxiety and depression medication while also drinking can render the medications useless, and they can also make you feel more sensitive to to alcohol and cause liver damage.
How To Get Help
No matter your age, there are ways to get help if you’re suffering from alcohol addiction, especially as an elder. The first step, though, is identifying the problem. This is either a realization and acceptance the individual has to come to, which may come at the hands of a diagnosis from a doctor after seeking help for various medical issues.
No matter the situation and how advanced the addiction and health problems caused by it are, you must remember that addiction is an illness, and not a choice. It’s not something that can be dropped easily. In fact, quitting an alcohol addiction cold turkey can potentially be fatal. Alcohol withdrawal symptoms can include:
- Raised blood pressure
- Stomach issues
- Delirium Tremens (severe confusion)
This is why it’s suggested that when you’re quitting alcohol, you slowly wean yourself off, especially if you’re inebriated in the the days prior to your decision. You should set up a schedule detailing how many drinks per day you will drink, reducing your intake by two drinks per day, until you are no longer drinking. For instance, if you average 10 drinks per day, spend five days reducing your intake to eight, then six, then four, then two, and then on the fifth day, you can begin sobriety.
When looking for ways to get sober and begin your path to recovery, there are various treatments you can seek. These include:
Alcoholic Anonymous (AA)
Support groups like AA are available to share your story and for you to listen to the stories of others to help you relate and recover in a group setting. There are mentors (also known as “sponsors”) at these meetings who are also going through recovery to help you work through fears, emotions, and temptations.
There are both inpatient and outpatient rehab facilities that can tailor to your lifestyle, like if you’re working or have children or other people you remain a guardian to.
Working with therapists can help addicts help find underlying causes for why the addiction started in the first place and how you can repair yourself and relationships as you recover.
It’s important to remember that there is always help and a support system out there for you, no matter your age.