OLDER ADULTS ARE DRINKING MORE. COULD THAT POSE A PUBLIC-HEALTH RISK?

Drinking among older adults has trended higher over the past two decades, while at the same time holding steady for middle-aged adults and falling among those under 34, according to a 2023 Gallup report.

The guidance for older adults age 65 and older is to limit their consumption to one drink per day, and it’s even less than that for women, according to the National Institute on Alcohol Abuse and Alcoholism (NIAAA). One drink consists of 14 grams of alcohol, which is generally contained in 12 ounces of beer, 5 ounces of wine and 1.5 ounces of spirits. 

But these are just guidelines.

“That any amount of alcohol is 100% safe is not true or accurate,” said Brent Smith, a physician and board member with the American Academy of Family Physicians and program director for the Mississippi Delta Family Residency Program. “The recommendations are made in consideration of a normal older adult. But for those over 65, we tend not to see any who are not on any medicine. It’s no secret that the amount of chronic diseases go up as we age, and most are made worse with drinking.” 

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Data from the National Survey on Drug Use and Health indicate that about 20% of adults age 60 to 64 and around 10% of those over age 65 report binge drinking.

From 1997 to 2014, drinking rose by an average of 0.7% a year for men age 60 and older, while binge drinking remained stable, according to a study detailing trends in alcohol consumption among older Americans. For women of the same age, drinking rose by an average of 1.6% a year, while binge drinking rose 3.7% a year, according to the study.

As the population of older adults in the U.S. continues to grow, this could highlight an emerging public-health issue. 

“Of concern is the rapidly growing number of drinkers aged 65 and older,” NIAAA Director George Koob said in a statement. “While the percentage of people 65-plus who consume alcohol each month increased by 13% between 2002 to 2020, due to the size of the aging baby-boomer cohort, the actual number of drinkers in that age group increased 82% during that time.”

The Centers for Disease Control and Prevention estimated that there were 175,756 alcohol-related deaths from 2020 to 2021, and that older adults age 65 and older accounted for 37% of those deaths.

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Older adults who take certain prescribed medications or have some medical conditions are advised not to consume alcohol at all. Medications that interact badly with alcohol include some over-the-counter drugs such as aspirin, acetaminophen, cold and allergy medicine, cough syrup and sleeping pills. Pain medication and medicine for anxiety or depression also don’t mix well with alcohol, according to the NIAAA.

“What we’re seeing in practice and in clinic is more issues of the effects of alcohol on the older population. We’re seeing alcohol as a substitute for proper mental healthcare,” Smith said. “Since the onset of COVID, these problems have gotten worse. Alcohol is used as a treatment for issues you may not want to acknowledge you have or may not know how to get help for. Treating those feelings with alcohol is not a safe alternative for care.”

According to a study called “COVID-19 Coping Study of US Adults ≥55,” 11% of older adults reported drinking more each week after the pandemic began than before the pandemic. The odds of increased consumption were twice as high if a respondent reported loneliness or had symptoms of anxiety or depression. If someone had all three, they were 3.8 times more likely to report drinking more.

“COVID certainly contributed to the increase,” said Olivera Bogunovic-Sotelo, assistant professor of psychiatry at Harvard Medical School and an expert on alcohol, drugs and addiction. “Older adults also deal with more loss — retirement, the loss of partners.”

Total alcohol sales per capita went up more from 2019 to 2021 than in any two-year period since 1969, according to the NIAAA.

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Alcohol and the older body

As people age, they tend to lose muscle mass and gain fat, so they feel the effects of alcohol more quickly and potently, Smith said. Changes in enzyme activity and general liver health during aging also help contribute to higher peak blood-alcohol concentrations and slower clearance of alcohol from the body, according to the NIAAA.

“The consequences of drinking are even worse for women,” noted Bogunovic-Sotelo.

Women, who tend to have lower muscle mass and lower overall weight than men, experience alcohol-related harm at lower levels of drinking than men, according to the the NIAAA. 

According to the National Survey on Drug Use and Health, 20% of adults age 60 to 64 and about 10% of those age 65 and older report current binge drinking. For women, binge drinking generally means consuming four or more drinks in a two-hour period, while for men it means consuming five or more drinks in the same time frame, according to the Centers for Disease Control and Prevention.

Older patients also are more prone to falls and tend to have weaker bones, Smith said. “Adding alcohol to that is a recipe for disaster.”

Alcohol-related medical emergencies among older adults that resulted in visits to an emergency department increased by 50% from 2006 to 2016, according to the NIAAA.

Additionally, much of the alcohol use by older adults goes underreported and untreated.

More than half of U.S. adults age 65 and older who used alcohol and had a healthcare visit in the past year were not asked about their alcohol use, according to a 2021 study by researchers at Columbia University’s Mailman School of Public Health.

“As physicians, we need to do more to create a safe space for patients to tell us honestly what they’re doing,” Smith said. “For it to be productive, we also need to ask the right questions in a way that feels safe for the patient to answer in an honest way.”