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Alcohol and Older People

For many older people, drinking is an important and enjoyable part of a social life. However, people age at different rates, and older people who drink need to reassess their drinking regularly because:

the body's tolerance for alcohol decreases with age;
alcohol can increase the risk of falling, and the risks from driving; and
alcohol can interact with medications.

While alcohol can also have some health benefits for older people, by reducing the risk of heart disease, these benefits are gained from a very low level of drinking (less than 1 standard drink a day for women, and 1 to 2 standard drinks a day for men), and can equally well be gained by a healthy life style.

Why are older people more at risk from alcohol?

In general, older people tend to drink less than people do in their younger or middle years. However, approximately 46% of people aged over 60 years regularly drink alcohol and 26% occasionally drink alcohol. And those who do drink need to be aware that a number of factors increase the likelihood of experiencing alcohol-related harm:

As people move into older age brackets, their tolerance for alcohol tends to decrease. This is because when alcohol is absorbed, it is distributed throughout the body's total water content, but the volume of total body water decreases with age, so a given amount of alcohol produces a higher blood alcohol concentration [BAC]. This effect is relevant to people aged over about 70 or 75 years, although there is considerable variation from person to person.
Coupled with this, there may be a reduced capacity for the nervous system to tolerate alcohol.
Older people often take regular medication, which may interact with alcohol to cause unpleasant or dangerous side effects. The risk is considerably greater when a number of medications are involved.
Falls are an increasing risk with advancing age, and this risk is also increased by intoxication, with potentially serious and disabling consequences.
Driving may be influenced by the effects of ageing, particularly visual loss and slowed reaction time. Again, any risk in this area can be increased by alcohol, and by the increase in BAC, with the potential to affect others as well as the driver.

Health care workers need to be aware that an alcohol dependence problem in older people can be mistaken for a number of medical or psychiatric conditions common among older people, such as depression, insomnia, poor nutrition and frequent falls. Consequently, alcohol-related problems may go undiagnosed or be treated inappropriately in this age group. Health care workers should therefore routinely discuss alcohol use with older patients.

Health benefits to older people from a small amount of alcohol

There is strong evidence that low risk drinking reduces the risk of heart disease in people from middle age onwards (from about 40-45 years of age for males and 45-50 for females): · This protection comes from drinking relatively small amounts of alcohol: approximately 1 to 2 standard drinks per day for men, and less than 1 per day for women. · The benefits appear to be associated with all types of alcoholic drinks. · There is no additional benefit from drinking larger amounts; and large amounts of alcohol may actually increase the risk of illness and death from heart disease. · People who choose not to drink alcohol should not be encouraged to drink to gain any potential health benefit, as there are other ways of preventing heart disease, such as giving up smoking, regular exercise, a healthy diet, or taking small quantities of aspirin. A combination of these approaches achieves better results than any one on its own.

Older people who drink alcohol:

are advised to consider drinking less than the levels set in the guidelines for the general population (see box below)
may need to further reduce their drinking or stop it altogether, if they are taking medications, in order to avoid harmful interactions with those medications.

Older men should consider:

drinking less than an average of no more than 4 standard drinks a day, and no more than 28 standard drinks over a week;
drinking less than 6 standard drinks in any one day;
having at least one or two alcohol-free days per week.

Older women should consider:

drinking less than an average of no more than 2 standard drinks a day, and no more than 14 standard drinks over a week;
drinking less than 4 standard drinks in any one day;
having at least one or two alcohol-free days per week.

Adapted from:
Australian Department of Health and Ageing, Australian Alcohol Guidelines Fact Sheets www.alcoholguidelines.gov.au

Principal source:
National Health and Medical Research Council (NHMRC) (2001). Australian Alcohol Guidelines: Health Risks and Benefits. NHMRC, Canberra.

Other sources:
Alcohol in Australia: Issues and Strategies. (2001) Commonwealth Department of Health and Aged Care, Canberra.

Australian Institute of Health and Welfare (AIHW) (2002) National Drug Strategy Household Survey 2001: First Results. AIHW, Canberra.

Single E, Ashley M, Bondy S, Rankin J and Rehm J (1999). Evidence Regarding the Level of Alcohol Consumption Considered to by Low-Risk for Men and Women. NHMRC, Canberra.

The body's tolerance for alcohol decreases with age.

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