Alcoholism

Gerontologists, health and social services providers have been slow to recognize that a significant number of older adults have alcohol problems. Among those age 65 and older, an estimated 2 to 10 percent have a significant alcohol problem.

Alcoholism is not gender-related; between one-third to one-half of alcoholics are women. There is a genetic component; children of alcoholics have a two to four times greater risk of alcoholism than children of non-alcoholics.


Defining Alcohol Abuse

Alcoholism is a chronic, progressive and often fatal disease that typically has periods of remission and relapse. Alcohol abuse refers to the recurrent use of alcohol that causes impairment in one or more of the following:

1. a failure to fulfill obligations at home or work
2. legal problems
3. social and interpersonal problems
4. use of alcohol in physically hazardous situations

Alcohol Dependency

Alcohol dependence is characterized by tolerance (i.e., increased amounts are needed to achieve an effect), withdrawal (i.e., symptoms occur when intake is reduced or stopped), and a pattern of compulsive use.

Adverse Health Effects

Alcoholism has many adverse health consequences that threaten the independence of older adults The psychiatric consequences of alcoholism include depression and cognitive deficits such as memory loss related to vitamin deficiencies (e.g. particularly the B vitamins). In addition, alcoholics are at a high risk for malnutrition because of their decreased caloric and protein intake as well as malabsorption related to gastric problems. Common and major health problems seen with chronic alcoholism are cardiovascular disease, cirrhosis of the liver, seizure disorders, pneumonia and urinary tract infections; and gait and balance disorders.

Lifelong vs. Late Onset Alcoholics

There are two types of elderly alcoholics: the life-long alcoholic and the late-onset alcoholic. The majority are young alcoholics who have survived into late life despite their alcoholism. The mortality rate among alcoholics is estimated to be about 2.64 times higher than among their nonalcoholic peers (Moos et al., 1994). Most older alcoholics have multiple chronic conditions: heart disease; pulmonary disease; cirrhosis; gastric, pancreatic and endocrine disorders; and psychosis. Older alcoholics are typically noncompliant with treatment and have a poor health prognosis.

An individual may become a late-onset alcoholic in response to specific stressors and losses in late life. Situations which can increase vulnerability to alcoholism include: (1) retirement, (2) the death of spouse, family or friends; (3) medical illness, pain and disability, and (4) loneliness. Late-onset alcoholics are usually the most responsive to treatment in an alcohol recovery program.

Alcohol may be more dangerous as we grow older

Older adults who drink the same amount of alcohol as a younger adult will have a higher blood alcohol level. This is primarily due to age-related changes in the absorption and distribution of alcohol. In addition, the amount of alcohol that is safe may be much lower among individuals who are taking medications. Many of the drugs commonly used by older people can interact adversely with alcohol.

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