An older adult's response to alcohol is much stronger as metabolism slows down, said Dr. Stephanie Collier, director of education in the division of geriatric psychiatry at McLean Hospital in Massachusetts.
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Retirement may be time for a lot of fun things, but an increase in drinking shouldn’t be one of them, experts say.
Older adults who do drink do so more frequently than people younger than 65 years old, he added.
“The Baby Boomer cohort (born from 1946 to 1964) is changing the landscape of alcohol use among older people in the US in two key ways,” Koob said via email. “First, they have always had a tendency to drink more, as well as use other drugs more, than the cohort before them, so the percentage of older people who drink is going up.”
The second way is from sheer numbers. The baby boomer generation is large, so the number of people who binge drink, develop alcohol use disorder and die from alcohol is on the rise, he said.
“The rapid growth in the number of drinkers over age 65 could place an increasing burden on our healthcare system,” he said.
Conversations around alcohol have been changing as more people have moved toward alcohol alternatives for a healthy lifestyle, but that culture has been led largely by younger people, Koob said.
“Given alcohol’s historical role in the fabric of everyday life … the aged population may be less aware of the harms,” he said.
A lower tolerance as you age
The first thing older adults should know is that a person isn’t going to react to alcohol the same way in their 70s as they did in their 30s, Koob said.
“The body changes as we age, and these changes render us more susceptible to some of the harms that stem from alcohol use,” he said.
As people age, there is a decrease in the enzyme that metabolizes alcohol, said Dr. Stephanie Collier, director of education in the division of geriatric psychiatry at McLean Hospital in Belmont, Massachusetts. Older people’s response to a drink is going to be much stronger as their metabolism gets slower, she added.
There is also a reduction in a person’s body water as we age that contributes to a higher blood alcohol concentration, so the same dose of alcohol at a younger age has a much greater impact years later, Koob said.
The risks of drinking for older adults
Those changes on how alcohol affects the body have serious consequences for healthy aging, Koob said.
The impacts of alcohol on things such as driving performance, reaction time, memory and balance are bigger in older adults than younger drinkers, he added.
Balance is particularly a problem considering that the leading cause of injuries among adults ages 65 and older — and studies suggest falls while intoxicated tend to be more severe, Koob said.
Combining alcohol and medication is also risky, and almost 90% of older adults are taking at least one medication regularly, Collier said.
“One study found that older adults are more likely to experience depressed breathing than young adults following a combination of alcohol and opioids,” Koob said. “This is concerning given that opioid overdoses lead to death primarily by depressing breathing.”
Alcohol can also weaken the body’s ability to fight infections, which is even more concerning after the Covid-19 pandemic had such a big impact on the older population, Koob added.
Less alcohol is better
Unfortunately, any amount of drinking just isn’t healthy, Collier said. She recommends her patients not drink at all or switch to nonalcoholic beer if it’s part of their routine.
If that sounds like a tall order, she recommends trying to take a one- or two-week pause from drinking and seeing how you feel.
“If you decrease your alcohol intake and feel better, your body is telling you something,” Koob said in an email.
It can be harder to spot alcohol use disorder or problem drinking in older adults who may be retired, living alone or socializing less because the signs are less overt, Koob said.
There are screening tools available to help decipher whether your drinking is a problem, like the Short Michigan Alcoholism Screening Test–Geriatric Version (SMAST-G), he added. But clinicians should also be asking their patients about drinking behavior regularly.
The current Dietary Guidelines for Americans recommend no more than two drinks in a day for men and one for women, Collier said. But less is better, Koob added.
“We believe that people at any age could benefit from stepping back and taking a look at their current relationship with alcohol,” he said. “We also think that cultivating alternatives to alcohol use for relaxation, socializing, and dealing with stress can result in less alcohol use and better health.”
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