How Alcohol Use Disorder Differs in Older Adults

Alcohol use disorder (AUD) is a dependence on alcohol characterized by cravings and an inability to control one’s drinking. AUD is often overlooked in older adults or mistaken for other conditions.

Key takeaways:
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    Alcohol use disorder (AUD) is overlooked in older adults or mistaken for other conditions. Detection of AUD requires special consideration of a person’s health history and life circumstances.
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    Alcohol use in people over 60 has risen over the last two decades and is associated with adverse health events.
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    Given that the last of the baby boomers are approaching age 65 – amounting to more than 71 million seniors by 2030 – proper screening and identification of AUD will be increasingly important.
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    Treatment for AUD is just as successful later in life as it is for younger people.

Defining the problem

The Dietary Guidelines for Americans 2020-2025 states that moderate drinking for adults 60 and older is:

Less than one drink for women per day.

Less than two drinks for men in a day.

A drink is 12-oz beer, 5 oz glass of wine, or 1.5 oz of liquor.

At-risk drinking

Consuming more than the daily-recommended amount of alcohol, which increases the chance of problems and complications.

Binge drinking

Consuming more than four and five drinks within two hours for women and men respectively. Occurs in 20% of drinkers aged 60 to 64 and 11% of those over 65.

Problem drinking

Adverse personal, professional, and/or social consequences happen because of alcohol consumption.

Alcohol dependence or AUD

A chronic disease characterized by periods of intoxication and withdrawal despite consequences. Affecting up to 22% of older adults in healthcare settings.

Rates of AUD are lower in the older population compared to younger adults. However, side effects of heavy drinking include:

  • Disorientation
  • Weight changes
  • Bladder problems

These are often blamed on coexisting issues like memory loss, diabetes, or medications. So, the underlying alcohol problem goes undetected and remains underreported in elders.

Seven stresses on the elderly body

1. The older we are, the harder it is for the body to process and eliminate alcohol. With age, there is less total body water and the metabolism is less efficient. Therefore, alcohol remains in the system longer. This taxes the liver. Mixing alcohol with prescription meds can be dangerous. Many cold medicines sold over the counter contain alcohol.

2. Older drinkers may experience intoxication sooner, in a delayed fashion, or with greater intensity than their younger counterparts depending on their health profile and medications. Any of these scenarios increase the risk of accidents or injury particularly due to a fall.

3. Alcohol can raise or lower blood sugar depending on the drink’s ingredients. This can be serious for those with undiagnosed or poorly controlled diabetes. An additional nutritional consideration is that alcohol provides “empty” or low-quality calories for those with weight concerns.

4. Drinking alcohol causes increased water loss through urination. This diuretic effect induces urinary frequency and dehydration resulting in problems for older adults (especially for those with heart or kidney failure) such as:

  • Electrolyte imbalances
  • Low blood pressure
  • Falls

5. Heavy alcohol use impairs reasoning and decision-making. Uninterrupted, long-standing drinking is known to cause dementia.

6. Nerve cells that coordinate our movements are negatively impacted by alcohol abuse. Uncontrollable shaking – called tremors – can develop in the head, arms, and hands. Walking and certainly operating any vehicle become precarious.

Falls are a leading cause of disability and death in older adulthood.

7. Over time, alcohol can alter the lining of the gastrointestinal tract, limiting its ability to absorb nutrients. Those with AUD may develop chronic conditions such as gastric bleeding and anemia.

At-risk times

The following are higher risk times later in life for developing AUD.

Retirement – Offers more time to drink and, depending on one’s social situation, more access to alcohol. Greater free time may also result in boredom and depression, which are associated with problem drinking in older adulthood.

Of note, Baby Boomers are reaching retirement age. This group grew up in the counterculture of the 1960s and the 1970s when the drinking age was lowered to 18 for a time and perceptions relaxed around drug and alcohol use.

Loss – The chances of a spouse or other loved one dying increase with age. People drink more when bereaved.

Injury and infirmity Growing older mean an increased chance of injury, particularly from falls.

Change in financial circumstances – Loss in investments or other expected income over time.

Altered living situation – Moving or children leaving the home (e.g., “empty nest syndrome”).

The shift in family roles – Becoming a caregiver or guardian for a loved one or becoming dependent.

Warning signs

If coexisting with one or more of the above transitional periods, any of the following physical or emotional signs should trigger a medical evaluation and screening for AUD.

Mood instability (irritability, depression, anxiety) Memory or concentration disturbances Observable changes in sleeping patterns
Confusion or disorientationChanges in eating habitsWeight loss and muscle wasting
Frequent fallsPoor hygiene and self-neglectImpotence
Daytime drowsiness or apparent sedationWithdrawal from friends and usual activityUnexplained complaints about chronic pain

Screening

A clinician will gather information including the amount of alcohol you consume and how often, whether these have progressed, and if you’ve suffered any harmful or unwanted results from drinking. The following are validated tools used to screen older adults for AUD:

  • The CAGE Questionnaire
  • Michigan Alcoholism Screening Test – Geriatric and Short Versions (MAST-G or SMAST-G)
  • Alcohol Use Disorders Identification Test (AUDIT or AUDIT-C)
  • The Comorbidity-Alcohol Risk Evaluation Tool (CARET)

Tips for treatment

Ask your health provider or therapist for information on an alcohol treatment center, one offering programs directed toward older adult recovery.

Attend a local recovery meeting or visit Alcoholics Anonymous.

Contact the SAMHSA hotline at 1-800-662-HELP (4357).

The problem of AUD not only exists in the elderly population but also is expected to grow alongside it. Alcohol is harder on the mature body and will complicate many conditions. Occurring later in life and often during transitional periods, the physical signs of AUD are often attributed to other issues. Screening for problem drinking or AUD is available through medical or behavioral health providers. Tailored treatment programs make recovery successful for older adults.