Alcohol: The Growing Threat to Seniors

Older Americans are Drinking More. New Research Shows They Shouldn’t

       Remember when word was that a glass of red wine was good for you and may even protect you from heart disease? Think again.

     More and more research now suggests that this is not the case. The Mayo Clinic’s stark assessment of the matter? Drinking alcohol in any amount carries a health risk.

     Yet older Americans, particularly older women, are drinking more alcohol, setting themselves up for serious health issues like cancer and preventable death. The annual number of alcohol-related deaths for 2020 through 2021 exceeded 178,000 according to the Centers for Disease Control and Prevention and an analysis by the National Institute on Alcohol Abuse and Alcoholism (NIAAA) said 38 percent of those deaths were people over 65.

          In addition, the NIAAA points to data from the 2023 National Survey on Drug Use and Health which indicate approximately 20 percent of adults aged 60-64 and 12 percent over age 65 report current binge drinking. (The NIAAA defines binge drinking as a man consuming five or more drinks and a female consuming more than four drinks in about two hours.)

      “Survey data suggest the percentage of older adults who drink alcohol each month is increasing, particularly for women, leading to a narrowing in the gender gap,” says Dr. George F. Koob, director of the National Institute on Alcohol Abuse and Alcoholism. “The percentage of people 65+ who drink alcohol each month increased about 16% between 2002-2022 (from 37.7% to 43.9%). However, due to the increase in the size of the population 65 and older, the total number of older drinkers actually increased 95% between 2002-2022, from 12,778,000 to 24,906,000.”

     More importantly, Dr. Koob adds, “Because the size of the group is so large, the sheer number of people who drink, engage in binge drinking, develop alcohol use disorder, and die from alcohol is growing quickly. And this rapid growth in the number of drinkers over age 65 could place an increasing burden on our healthcare system.” (By 2040, there will be an estimated 80.8 million people aged 65+, more than double the number in 2000 of 35 million.)

     Even if the rates of alcohol measures among adults 65+ stayed the same, adds Dr. Koob, he would still expect about a 50% increase in the numbers of drinkers, binge drinkers, people with AUD (Alcohol Use Disorder,) and cases of liver disease, by 2040. “In reality, both the rates of drinking and the number of drinkers is increasing,” he says.

          But alcohol has numerous negative side effects, disrupting sleep, damaging the intestines, adversely affecting high blood pressure and more. A meta-study concluded that the consumption of any alcohol should be considered a risk factor for high systolic blood pressure, and increased the odds for abnormal heart rhythm, generally referred to as AFib - atrial fibrillation, both of which can lead to a stroke and other cardiovascular issues.

          Even in adults without high blood pressure, readings may climb more steeply over time if the number of daily alcoholic drinks goes up, according to an analysis of seven international research studies published last year in Hypertension, an American Heart Association journal.

    Alcohol also increases inflammation in the body, which rises as we age anyway. Inflammation can contribute to a decreased quality of life, cognitive decline, and a variety of diseases, including heart disease and cancer.

Chronic excessive alcohol use, says Dr. Koob, is associated with higher levels of inflammation in the body including the brain, increasing the likelihood of heart disease. Alcohol also irritates tissue, disrupting the intestinal barrier which allows endotoxins from bacteria to cross over in the body and trigger widespread inflammation. This can lead to liver damage and, ultimately, damage to the brain.

    In addition, alcohol interacts negatively with a wide range of medications.       

     “Particularly those that produce sedative effects,” says Koob. He lists such medications as benzodiazepines for anxiety, muscle relaxers, sleep medications such as Ambien and Lunesta, and opioid pain medications.

       Over-the-counter drugs such as aspirin, acetaminophen, cold and allergy medicine, and cough syrup do not do well with alcohol either. One thing to remember is drinking too much for anyone over a long period can also exacerbate existing conditions like osteoporosis, diabetes, and mood disorders, and can lead to some types of cancer including that of the liver, the breast, and the colon/rectum.

            People drink for a plethora of reasons but as they age, they can develop a reliance on alcohol because of life-altering changes - the death of a loved one, failing health, reduced finances, and having to move suddenly. These disruptions can cause loneliness, boredom, anxiety, or depression, all of which some folks tend to remediate with alcohol.

          The danger is that as we grow older, the body has a harder time metabolizing alcohol, increasing our sensitivity to it. This is true, particularly for women, who often have less muscle mass than they did when younger, so the effects of drinking alcohol come on faster.

       One of the reasons older drinkers react to alcohol differently than young drinkers is that the same amount of alcohol produces higher blood alcohol in an individual, says Dr. Koob. Water in the body tends to decrease with age due to an increase in the proportion of body fat. The reduction in body water contributes to higher blood alcohol concentrations (BACs) and a greater degree of subjective intoxication in older drinkers relative to younger drinkers who consume the same dose of alcohol. Peak BACs produced by alcohol, Dr. Koob says, increase by roughly 33% across the lifespan, from age 21 to 81, as a result of decreases in body water.

      The result - poor balance and coordination, dizziness, slower reaction times, impaired driving performance, and difficulty processing information – all put us at risk for falls, hip and arm fractures, and car crashes. In fact, alcohol causes about 65 percent of fatal falls in the U.S. according to the National Institutes of Health. 

     “Falls,” says Dr. Koob, “are the leading cause of injuries among adults aged 65+, and research suggests 1 in 10 older adults are injured in falls each year. Studies suggest the injuries sustained from falls while intoxicated tend to be more severe than injuries from falls that do not involve alcohol.”

          Yet even low-risk drinking is associated with higher mortality among older adults with health-related or socioeconomic risk factors, according to a new study published in the JAMA Network Open this past August.  It was linked to an increase in cancer deaths among older adults.

     What about moderate drinking? Defining it varies and is different for men and women.  In the United States, moderate drinking is defined by the U.S. Department of Health and Human Services and U.S. Department of Agriculture 2020-2025 as one drink a day for women and two for men. Examples of what one drink is: 12 fluid ounces of regular beer, 5 fluid ounces of wine and 1.5 ounces of hard liquor.

But can it be considered a safe way to go? “The evidence for moderate alcohol use in healthy adults is still being studied,” says the Mayo Clinic. “But good evidence shows that drinking high amounts of alcohol are clearly linked to health problems.”

And while drinking moderately is better, the risk isn’t zero. Some experts say any amount of alcohol consumption increases the incidence of all kinds of cancers.

People who drink daily do not necessarily have alcohol use disorder, says the National Institute of Aging. And not everyone who misuses alcohol or has AUD drinks every day. But drinking heavily, even only now and then, can have harmful effects.

Why do older Americans routinely underestimate the growing evidence about the hazards of drinking?

Dr. Brent Smith, a family physician in Greenville, Mississippi, and a board member of the American Academy of Family Physicians, says some of the factors for alcohol use and misuse among seniors include: “First,” says Dr. Smith, “is increasing social isolation.  Tech has advanced fast, leaving older people behind, and this leads to loneliness and a sense of isolation which are predictors of alcohol use.’’

    “Second, it’s a lot easier to drink alone because there’s no accountability to not drink to excess around others or maintain a sense of decorum.  Some studies showed red wine can help in preventing heart disease, but the truth is, the reduction in risk is so much less than all the other things we ask patients to do. People say if they drink in moderation, it’s OK. But it’s not worth it given all the other risks that come with it.”

     “Alcohol has long been a part of the culture, and, for many years, research findings were interpreted as suggesting that small amounts of alcohol might actually prolong life,” says Dr. Koob. “We now know that earlier studies were flawed in ways that skewed the findings toward suggesting health benefits that do not exist...It is quite clear that the risks of harm begin at far lower levels than we once thought. For instance, the risk of breast cancer for women appears to increase by roughly 10% with one standard serving of alcohol per day, such as a glass of wine, a beer, or a shot of spirits.”

      Family physicians can play a crucial role in detecting, diagnosing, treating, and supporting their patients who have problems with alcohol because people may see their GP more than any other healthcare provider. Yet according to a 2021 study by Columbia University Mailman School of Public Health researchers, more than half of U.S. adults age 65 and older who drink alcohol and had seen a healthcare provider in the past year were not asked about their alcohol use. The study showed that older women who have clear-cut risks from drinking were less likely than older men to discuss their alcohol use.

Dr. Koob believes people will make better choices about alcohol if they are presented with health information, particularly when it is offered by physicians. 

        “Screening followed by brief interventions can be effective at reducing alcohol use among adults,” Dr. Koob says. “Physicians are in a position to connect older adults to additional care if needed and given the risks of alcohol for older drinkers…. Every patient 65 and older should be asked questions about their drinking at every doctor’s visit, whether it is in person or via telehealth.”

    “A lot of primary doctors are overworked,” says Dr. Smith of the AAFP. “They are often focused on the acute issues that brought you to their office and any chronic medical issues you have that require regular follow-up, and nuanced stuff like AUD and drug abuse can be pushed to the back and get neglected.  Also, there must be an establishment of trust, and the patients must feel safe, be open about it, and not worry that they'll just be labeled as alcoholics. A lot of patients who know they have something wrong don’t tell you because they feel like (treating) it would require too much time, money, and effort,” he adds.

  There are all kinds of treatment programs and information about cutting down on drinking (talk first with a professional). The NIAAA’s Treatment Navigator can help people find treatment for alcohol problems, while its Rethinking Drinking website provides resources to help people assess their drinking habits and decide whether and how to make a change.

    Ultimately, though, many doctors like Dr. Smith, would prefer their patients stay away from alcohol altogether. “If you gave a physician an option of a patient who drinks and exercises all the time,” he says, “or one that doesn’t drink and never did any exercise, they’d choose the latter,” he says.