When Alcohol Is a Problem
Older people are less likely than younger people to drink heavily or to be alcoholics. This observation seems reassuring. However, there is no doubt that alcohol is a problem for many older people. In fact, more older people are hospitalized for alcohol- related problems than for heart attacks.
When is alcohol considered a problem? It is a problem when people need to drink more and more alcohol to get the same effect and have withdrawal symptoms if they stop drinking. Such people have alcohol dependence. Drinking is also a problem if it causes physical, social, or psychologic harm. In such cases, alcohol abuse is diagnosed. Alcohol dependence or abuse is sometimes called alcoholism.
For older people, formal definitions of dependence or abuse are less meaningful—for them, drinking any amount of alcohol can interfere with functioning. The aging body processes alcohol differently. As a result, alcohol has a greater effect. So after drinking the same amount, older people are more impaired than when they were younger. Drinking even a small amount can make them sleepy, confused, uncoordinated, and unsteady.
The more alcohol consumed and the more often it is consumed, the greater the risk of more serious problems, such as hip fractures. Heavy drinking can cause or worsen urinary incontinence, problems with walking, depression, sleep disturbances, memory loss, dementia, delirium, high blood pressure, and bleeding in the digestive tract. Nutritional deficiencies, particularly deficiencies of thiamin, folate, vitamin B6, niacin, and vitamin A, are more likely in heavy drinkers. Regularly consuming more than two drinks a day increases the risk of certain cancers (particularly those of the head, neck, and esophagus) and liver disorders.
Alcohol can interact with many drugs. When alcohol and drugs used to calm, relieve anxiety, or aid sleep (such as benzodiazepines) are combined, loss of balance, falls, and sleepiness are more likely, and reaction times are slower. Alcohol plus nonsteroidal anti-inflammatory drugs (NSAIDs) irritates the stomach and makes bleeding more likely. Aspirin increases the effects of alcohol in women, but not in men. Alcohol plus acetaminophen may lead to liver failure. So people who take acetaminophen daily are advised not to drink any alcohol.
How many alcoholic drinks are safe? Answers continue to be debated. A drink is considered to be 12 ounces of beer, 5 ounces of wine, and 1 1/2 ounces of liquor (such as whiskey). Most experts agree that older women should not drink more than one drink a day. For older men, the safe limit is thought to be one or two drinks. Adding to the confusion is evidence that drinking one or two drinks a day has some health benefits, such as a reducing the risk of coronary artery disease. With alcohol consumption, only a thin line separates potential health benefits from potential harm. For older people, less alcohol is definitely more in terms of health benefits.
