October 5, 2011

USA: Alcohol can cause many problems in older people

DANBURY, Connecticut / Danbury News Times / Article / October 5, 2011

Bridgeport geriatrician Dr. Beata Skudlarska of Bridgeport Hospital Center for Geriatrics, Stratford, CT, answers questions for this feature.

Q: My husband, who is 66, is a recovering alcoholic who has been dry for about three years. I have been reading about dementia and alcoholism. He drank heavily on and off for 30 to 40 years. In addition to that, he is a diabetic with neuropathy and has atrial fibrillation. He has little mobility, shuffles with a cane, and still drives. Much of the time he displays a quick wit and an interest in science-related topics, as well as political issues. However, he is experiencing memory problems, asking such questions as "Where are my keys?" and "Did she die a whole year ago? I thought it was just a month or two." He has gone from being gregarious and personable to quiet. We have seen a neurologist who looked at CT scans and reported that the neuropathy was not as bad as expected and that his brain has shrunk considerably. I am looking for an expert on this kind of dementia in the Seattle area. Do you have any ideas?  - Reader from Seattle

A: Quite a lot of press has been given in recent years to the potential health benefits of alcohol. Light to moderate consumption of alcohol has been associated with a reduced risk of coronary heart disease, stroke and dementia. Geriatric doctors wonder if the personality profiles and social characteristics of those who drink safe amounts may be responsible for this apparent protective effect more than the alcohol itself.

Many mature people overuse alcohol and do not report it to their doctor. Since they are often retired and do not have to show up for work or interact with other people, their habit gets unnoticed. Women also are more likely to start drinking at a later age.

It is estimated that about 8 percent of people in the U.S. over 65 may have an alcohol abuse problem. About 60 percent of the elderly drink and 5 to 10 percent are binge drinkers. It may be hard to believe, but Medicare, which is the major insurance for patients over 65, spends more on alcohol-related problems than on treatment for heart attacks.

Illustrative photo courtesy: the retreatcentre

There is no standard definition of what is a "safe" amount of alcohol when you get older. It is generally accepted that one 5-ounce glass of wine, one bottle of beer, or one 1.5-ounce shot of hard liquor a day is safe if you are a mature woman. You should be able to have one to two days in a week without any alcohol. Men tend to tolerate alcohol more and can have twice as much of it daily.

Age-related changes in our body mean that equivalent amounts of alcohol produce higher blood alcohol concentrations in older people. So, if you drank a certain amount as a younger person, when you get older, that same amount is likely to affect you much more.

Alcohol abuse in elderly people causes widespread impairments in physical, psychological, social and cognitive health. All aspects of their lives are touched. Serious medical disorders among elderly people who misuse alcohol are much more common than among the overall population of a similar age. Having more major illnesses, poorer self-perceived health status, more visits to the doctor, more depressive symptoms and less satisfaction with life are all reported by alcohol abusers. They also tend to have smaller social networks than non-heavy drinkers and people who have never drunk.

Excessive drinking makes you prone to hip fractures. This increase can be explained by falls while intoxicated, combined with a more pronounced decrease in bone strength in elderly persons with alcoholism compared with elderly nonalcoholics.

Alcohol-involved traffic crashes are an important cause of trauma and death in all age groups. The elderly are the fastest-growing segment of the driving population. In addition, older drivers tend to be more seriously injured than younger drivers in crashes of equivalent magnitude. Age may interact with alcoholism to increase driving risk. For example, an elderly driver with alcoholism is more impaired than an elderly driver without alcoholism after consuming an equivalent dose of alcohol, and has a greater risk of a crash.

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