Alcohol and Older Adults

The number of older people in the world is growing every year and their alcohol abuse is a rather acute medical and social problem. Heavy use and alcohol dependence is the second most common reason older people seek mental health care or any medical care in general.

It’s estimated that one-third of older individuals suffering from alcohol use disorder developed the problem later in life. In addition, some studies indicate that binge drinking among older adults has increased in recent years. In 2019, the Substance Abuse and Mental Health Services Administration estimated that more than 10% of U.S. adults aged 65 or older had at least one binge drinking episode within a month of surveying.

Alcohol dependence among the elderly is often referred to as hidden because most older people themselves do not want to admit that they abuse alcohol, and many of them are either socially isolated or lonely. Already adult children who live separately rarely ask their elderly parents about their attitude to alcohol, believing that such problems concern only the younger generation. Check out CEU Outlet’s 4-hour CE online course’ “Alcohol and the Family” to learn how alcohol use disorders of individual family members influence the entire family’s functioning and developmental outcomes of the system and its members.

In addition, the very fact of alcohol consumption is regarded according to a pessimistic scenario, since it is believed that older people are not able to change their lifestyle and give up alcohol. But the most important thing is that problems with alcohol can be hidden behind such conditions and diseases characteristic of the elderly, such as heart problems, depression, sleep disturbance and insomnia, impaired consciousness, dementia, and various kinds of neuropathies.

Alcoholism in the elderly is divided into two groups. The first includes those who have been “familiar” with alcohol for a long time, and their alcoholism was formed at a young or mature age. The severity of alcoholism in them is more pronounced, respectively, and they are more difficult to treat. The second group is the elderly who began to actively consume alcohol, being already in old age, most often after the age of 60-65, under the influence of many social factors. These factors include retirement, a decrease in interpersonal contacts, a decrease in communication up to loneliness, difficult social and living conditions. But, at the same time, the prognosis in the treatment of elderly people from the second group is quite favorable. The percentage of self-remission is very high when the provoking factors are eliminated.

An important factor in the development of alcoholism in old age is the very fact of aging and the psychological rejection of it, as well as the development of many diseases’ characteristic of this age. 

Frequent use of alcohol and alcohol dependence in old age is associated with a whole range of social and medical problems. The toxic effects of alcohol, combined with age-related changes in the brain, lead to the rapid development of psychoorganic diseases. Alcohol abuse in old age dramatically increases the risk of developing cirrhosis of the liver, cancer of the liver, upper gastrointestinal tract, colon and rectum, and prostate.

Increased Health Problems

Heavy drinking can exacerbate other health issues  that older adults commonly experience. Health conditions made potentially worse with heavy drinking include:

• Diabetes.
• High blood pressure.
• Congestive heart failure.
• Liver problems.
• Osteoporosis.
• Memory problems.
• Mood disorders.

A characteristic feature of depression in the elderly with alcohol dependence is a more severe course of the disease and a high risk of suicide.

A separate problem is the combination of alcohol intake with drugs that are taken in old age in large quantities either as prescribed by a doctor or on their own. The interaction of alcohol with drugs can change the effect of drugs on the body – weaken or, conversely, enhance their effect, as well as side effects. The negative consequences of the combined intake can be disorders of the heart, liver, kidneys, impaired consciousness, impaired coordination of movements, which significantly increases the risk of injury.

Because of the increased sensitivity to alcohol in older age, alcohol-related problems can occur even with small amounts of alcohol. Therefore, the dose of alcohol consumed is one of the main criteria for assessing the level of alcoholism. Together with the main symptoms of alcohol dependence – hangover, withdrawal syndrome, loss of quantitative and qualitative control, behavioral effects of alcohol are important diagnostic criteria.

Treatment Options for Alcoholism in the Elderly

Some physicians are very skeptical about the treatment of alcohol dependence in the elderly, but, nevertheless, the available data and studies indicate that it is possible to significantly reduce alcohol use with relatively simple preventive strategies. The most important of them is the conduct of motivational conversations, during which advice and motivation are given to reduce or stop drinking alcohol, to maintain a sober and healthy lifestyle.

The treatment of older people with alcohol dependence has some features that must be considered. These are low tolerance to alcohol, the severity of the clinical symptoms of alcohol withdrawal syndrome and an increase in its duration, frequent amnestic forms of intoxication. Considering that the alcohol withdrawal syndrome in the elderly is more severe and is often accompanied by impaired consciousness, it is better to treat it in a hospital under the constant supervision of staff.  

Infusion and detoxification therapy should include the restoration of disturbed water and electrolyte balance with the obligatory control of cardiac activity and kidney function, the use of a large amount of B vitamins, in particular vitamin B1. In the process of stopping the alcohol withdrawal syndrome, benzodiazepines, tranquilizers, and neuroleptics are used extremely carefully and dosed, since concomitant liver dysfunction changes their action in the direction of increasing sensitivity to them.

In order to prevent relapse of alcoholism, disulfiram-containing drugs can be used, but they should be prescribed and used with caution and for a short time, given its toxic effects that increase the risk of myocardial infarction and stroke. Therefore, for the purpose of anti-relapse therapy, it is better to give preference to various psychotherapeutic and hardware methods.

CEU Outlet offers a comprehensive course on alcohol use and the risk of communicable diseases. The purpose of this course is to provide clinicians with knowledge of the risks, diagnosis and treatment of alcohol abuse in the elderly. – See more at: CEU Outlet

But the main preventive measure and tactic for treating the development of alcohol dependence is to prevent social distancing from the elderly, both relatives and state social structures, to prevent the development of depression and loneliness, to observe simple norms and rules of a healthy lifestyle, as well as simple and kind communication.