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Alcohol: What’s Age Got to Do with It?

Alcohol—in the form of wine, distilled spirits, and beer—is one of the most common and accessible drugs in the world. In our own backyard, Washington state has an abundance of wineries, craft distilleries, and breweries. In fact, we rank second in wine production behind California, third in the production distilled spirits, and fifth in beer.

The popularity of craft and small batch alcohol production and tasting rooms have made consumption an experience, even entertainment. In addition, the purchase of distilled spirits has shifted from state-run liquor stores to grocery, drug, corporate, and privately run liquor stores—even retail outlets like Costco and Target—increasing accessibility. And they will deliver to your home.

Prompted by increases in alcohol purchasing and consumption during the COVID-19 pandemic, some researchers have begun to conduct studies to assess changes in adult alcohol use and its impact on health.

Light to moderate alcohol consumption might protect against Type II diabetes, promote heart health, and contribute to an extended lifespan; however, higher consumption rates lead to harmful effects such as insulin resistance, liver disease, and decreased motor control, and can be detrimental to cardiovascular and brain health.

How are consumption rates defined?

• Light drinking: three drinks per week on average over the past year
• Moderate drinking: more than three drinks but no more than seven drinks per week for women, and more than three drinks but no more than 14 drinks per week for men, on average over the past year
• Heavier drinking—more than seven drinks per week for women; more than 14 drinks per week for men, on average over the past year

Despite high consumption rates of alcohol among older adults, there is little focus on its effects in the context of aging and mental health. This is unfortunate, as the symptoms of alcohol abuse can often be mistaken or misinterpreted for other conditions, such as dementia, or dismissed as a natural part of the aging process.

When is drinking considered to be substance misuse?

According to the NIH’s National Institute on Alcohol Abuse and Alcoholism (NIAAA): “When a person has uncontrolled and problematic drinking, he or she may have a health condition called alcohol use disorder (AUD), commonly known as alcoholism. Health professionals use a list of symptoms to diagnose AUD. Depending on how many symptoms the person has, AUD can be mild, moderate, or severe. Even a mild disorder can lead to problems, so treatment is important.”

Why should higher alcohol consumption rates in older adults be a concern?

Consider these universal truths about alcohol:

• Slows reaction times
• Interferes with information processing
• Impacts coordination, can lead to balance problems, and contribute to falls
• Contributes to risk of dehydration, which in turn can lead to urinary tract infections, acute kidney injury, constipation, the development of skin conditions and pressure sores, adverse effects on mental performance, fatigue, weakness, dizziness, and increased risk of falls
• Affects judgment
• Contributes to negative outcomes when mixed with over-the-counter, herbal, and prescription medications
• May be a factor in domestic abuse, neglect, and self-neglect

What are the warning signs of alcohol misuse and abuse?

The Hazelden Betty Ford Foundation offers a comprehensive overview of the predictors, warning signs, and definition of Alcoholism and Alcohol Use Disorders. See their lists below for the warnings signs as well as physical signs and symptoms of alcohol addiction:

10 Warning Signs of Alcoholism

• Drinking more than planned or intended
• Failing to fulfill obligations at school, work, or home (making drinking a priority, despite responsibilities, leading to missed school or work)
• Continuing to use despite negative impacts on relationships, financial situation, or health
• Using in situations that could be physically hazardous, like drinking and driving
• Showing an increased tolerance to alcohol (drinking more in order to achieve the same desired effect). Because the brain changes with alcohol abuse, one of the first physiological signs of addiction is building up a tolerance.
• Experiencing physical or psychological withdrawal symptoms when attempting to stop drinking (anxiety, depression, insomnia, nausea, sweating, hand tremors/”the shakes,” confusion, seizures and/or visual hallucinations)
• Losing interest in once-enjoyed activities or becoming socially isolated
• Becoming dishonest or secretive, aggressive, moody, or temperamental—people who have an alcohol addiction often try to hide it.
• Craving alcohol, such as drinking first thing in the morning
• Spending an inordinate amount of time thinking about drinking, acquiring alcohol, and recovering from hangovers

Some Physical Signs and Symptoms of Alcohol Addiction

• Rapid weight gain or loss
• Slow or staggering walk
• Inability to sleep or stay awake
• Unexplained bruises or marks
• Glazed or red eyes
• Cold, sweaty palms or shaking hands
• Puffy face, blushing or paleness
• Nausea, vomiting or excessive sweating
• Low or no energy
• Depressed or anxious
• Deterioration of personal appearance or hygiene

Why should we be concerned about alcohol consumption as we age?

Concerns about older adults and drinking behavior are often overlooked or minimized by family, friends, and healthcare practitioners. We simply don’t talk about the effects, but we should. Alcohol is among the most misused addictive substances.

Alcohol may also metabolize differently as we age. One factor to consider is that it may take less alcohol to make you feel the effects.

As discussed above, alcohol can impair coordination, reaction time, and judgment, and increases the risk of household accidents, car crashes, and falls. Alcohol is a factor in suicides, burns, drownings, and homicides as well. In fact, according to the NIAAA, alcohol-attributable deaths are the third-leading cause of preventable death in the U.S.

Falls, no matter the cause, are particularly worrisome as we age. They are the Number One reason for emergency department visits by older adults. Falls are also the leading cause of injury in older adults, who are more likely to fall if they have:

• Balance problems
• Poor vision
• Cognitive changes, such as those caused by Alzheimer’s or another dementia
• Several medications

Rarely is there a mention of alcohol being a contributor to falls, yet we know it can be a factor in all the causes listed above.

What should you do if you are concerned about a loved one’s drinking?

You will find helpful, effective approaches in The Do’s and Don’ts of Alcohol Intervention with Older Adults (U.S. News and World Report).

Not sure what to do next?

Every family is different, but there are supports and strategies available to help you focus on creating a plan to move forward and to get the help you or your loved one needs, while respecting autonomy, independence, and dignity.

Here are some local organizations that are ready to offer help, resources, and support:

• Community Living Connections(Seattle & King County): Provides professional, confidential information and resources related to aging or disability issues, at no charge. Call toll-free 1-844-348-5464
• King County Behavioral Health and Recovery Division: Provides a wide variety of services, including crisis services, mental health treatment, substance use disorder treatment, and diversion and reentry services. Call the Client Services line at 206-263-8997 or toll-free 800-790-8049.
• Aging Life Care Association: Find an Aging Life Care Professional—also known as a geriatric care manager—near you who can assist with finding resources, supports, and ongoing care management for your older loved one and help your family navigate options.

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Contributor Sheila McKannay, MA, BA, CMC, is a Certified Care Manager at Aging Wisdom, an Aging Life Care (care management) practice based in Seattle, serving King County. Sheila has worked in the field of aging for over 30 years. It gives her great joy to help individuals and families navigate resources, find solutions, and and gain peace of mind.

This article originally appeared in the September 2021 issue of AgeWise King County.