Roughly half of adults ages 65 and older drink alcohol. Although experts continue to debate the possible health benefits of alcohol when consumed in minimal daily amounts, alcohol’s health risks in adults too often are overlooked by both family members and healthcare professionals. This may stem from the common belief that people who’ve lived a long time have earned the right to do whatever they wish, including drinking alcohol.
But here’s the reality: Older adults have significantly greater rates and intensity of alcohol-related problems. So whether you work in a hospital, home care, a community setting, or a long-term care facility, your role includes screening for alcohol use in older adults and promoting their health by teaching them about nonhazardous alcohol use.
Alcohol-related problems in older adults
Statistics show that approximately 20% of older men and 8% of older women drink more than the recommended number of drinks daily or weekly. Approximately 16% of persons ages 65 and older meet the criteria for an alcohol use disorder. Be aware that older adults tend to use alcohol for specific reasons, such as desire to “pass the time,” ease loneliness, promote sleep, or relieve pain.
In older adults, determining the effects of alcohol use, misuse, or dependency can be challenging because chronological age isn’t related specifically to functional abilities or quality of life. Also, it’s not always easy to distinguish the effects of alcohol use or misuse from those of aging or coexisting health conditions (such as impaired memory and other cognitive changes). With aging comes a reduction in short-term memory. Alcohol abuse increases the likelihood of short-term memory loss; under the influence of alcohol, a person may exhibit confusion and other signs resembling those of Alzheimer’s disease and other dementia forms. What’s more, short-term memory loss reduces one’s ability to control the use of alcohol and medications, as well as the ability to report the use of these substances.
Most alcohol-related problems in older adults may not meet the criteria for an alcohol use disorder, alcohol dependency, or alcoholism. Instead, older adults who drink are more likely to experience health problems, accidents caused by intoxication, or functional limitations. In this population, alcohol use directly correlates with exacerbation of chronic illnesses, falls, being assaulted, attempting suicide, or having an automobile accident.
Also, the physiologic effects of aging may increase the risk of adverse reactions from even minimal amounts of alcohol. These effects include decreased body water volume, reduced body mass, greater sensitivity of the central nervous system, and a slower metabolic rate. As a result, older adults experience intensified effects from even limited amounts of alcohol.
Classifying levels of alcohol use
Whether it’s beer, wine, or hard liquor, a standard drink contains about 14 g (about 0.6 fluid oz) of alcohol. To promote nonhazardous alcohol use, the National Institute on Alcohol Abuse and Alcoholism recommends that healthy men older than age 65 consume no more than three standard drinks in a day and no more than seven in a week. For older women, the recommendation is vague: They should have slightly fewer drinks per week. (The role of gender on alcohol’s effects in older adults needs to be fully investigated.)
When screening older adults for alcohol consumption, know that alcohol use is classified as nonhazardous, hazardous, or harmful.
- Nonhazardous use causes no identified threats.
- Hazardous use, defined as moderate to very heavy alcohol use, complicates the diagnosis and treatment of other medical problems, creates the potential for additional problems, and triggers negative effects of other substances (including drugs the patient may be taking to treat health problems). In healthy older males, hazardous use means consuming four or more drinks in one day; in healthy older women, three or more drinks in one day.
- Harmful use indicates the onset or progression of an alcohol use disorder. Such use involves binge drinking, defined as consuming five or more drinks at one time.
The chart, Understanding nonhazardous, hazardous, and harmful alcohol use by healthy individuals older than age 65, gives additional details on the three levels of alcohol use. It can be viewed by clicking on the PDF icon above.
The nurse’s role
To identify older adults (or any patients) who consume alcohol, you can use a screening tool. The screening session also provides an opportunity to begin discussing with the patient why it’s important to use alcohol in nonhazardous rather than hazardous or harmful ways. Key questions to ask during screening include:
“How often do you drink alcohol?”
“When you do drink alcohol, how much do you drink?” (Be sure to clarify the sizes of drinks, bottles, and glasses.)
“How often do you drink to help you fall asleep?”
“How often do you drink when you feel sad?”
“How often do you drink when you’re in pain?”
“How often do you drink and smoke a cigarette?”
“How often do you have a drink of alcohol and then drive?”<?p>
The patient’s answers help identify the pattern and level of alcohol use.
The Michigan Alcoholism Screening Test – Geriatric Version (MAST-G) also is recommended to identify patients with alcohol dependency. See the box by clicking on the PDF icon above.)
Educate and motivate older adults to use alcohol in a nonhazardous way, if at all. Nonhazardous use means very light to light consumption.
- Very light drinking translates to consuming alcohol once in a while and not on a routine daily or weekly basis.
- Light drinking means following the guidelines recommended by the National Institute on Alcohol Abuse and Alcoholism (2005).
Be sure to emphasize the importance of avoiding driving and other potentially dangerous activities while under the influence of alcohol and medications.
Know, too, that suicide is a significant problem among older adults. Some may drink in an attempt to relieve depression—yet alcohol can intensify depression. Encourage depressed patients not to use alcohol.
Finally, teach older adults that alcohol can interact with other substances, including nicotine and prescription and over-the-counter medications. Urge them to minimize alcohol use when taking benzodiazepines, warfarin, amitriptyline, aspirin, nonsteroidal anti-inflammatory drugs (especially acetamenophen), nitrates, and antihistamines. Explain that even relatively light alcohol use can lead to interactions with many other medications. Point out that taking numerous medications concurrently increases the risks of these adverse effects in older adults who have even a single drink of alcohol daily. For medications that can cause negative effects in the elderly, see the the .
Knowing that half of older adults consume alcohol can help you prevent problems related to its use. Begin the discussion of alcohol use by routinely asking patients, “How often do you drink alcohol?”
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Janice Cooke Feigenbaum is a clinical professor at the University at Buffalo School of Nursing in Buffalo, New York.
While alcohol use may be a problem in some older adults, the problem of clinical depression is a far greater problem that may account for their alcohol use as well as many of thier symptoms including problems with cognition. It may serve our patient well if we root out the cause of the alcohol use and treat the underlying depression rather than just taking away their attempt at “self” medication.
As an RN whose husband is a recovering alcoholic, it is refreshing to see an article on alcohol use/abuse as they were few and far between when I was searching for answers. Thank you!
Very useful. Wonderful topic–THANKS for a great journal!
What a nice overview for an important primary care problem! I appreciate the clinical emphasis on the older patient, who many overlook in relation to addictive behaviors. Thanks for this great clinical article!