Alcohol Use Disorder and the Elderly: Impacts of Alcohol Misuse on Older Adults

Statistics on Alcohol Use Among Older Adults

Alcohol is the most used substance among adults aged 65 or older, and alcohol use disorder is a serious disease affecting many older adults.¹ It’s estimated that one-third of older individuals suffering from alcohol use disorder developed the problem later in life.² In addition, some studies indicate that binge drinking among older adults has increased in recent years.³

• In 2021, the Substance Abuse and Mental Health Services Administration (SAMHSA) estimated that more than 11% of U.S. adults aged 65 or older had at least one binge drinking episode within a month of surveying.³ The Centers for Disease Control and Prevention (CDC) defines binge drinking as consuming enough alcohol to bring a person’s blood alcohol concentration (BAC) to 0.08 g/dl or above.⁴ For women, binge drinking generally means consuming 4 or more drinks in a 2-hour period. In men, it means consuming 5 or more drinks in the same time frame. It’s important to note, however, that these estimates include adults of all ages. Because body composition changes with age, on average, any given amount of alcohol could result in a relatively higher blood alcohol concentration in an elderly individual than it would in a younger person.⁵
• The same survey found that nearly 3% of adults aged 65 and older drank heavily within the month of surveying.³ The CDC defines heavy drinking as consuming 15 or more drinks per week (for men) and 8 drinks per week (for women).⁵
• Past research has indicated that as many as 4% of elderly adults suffer from alcohol use disorder.⁶

Unfortunately, alcohol misuse among older adults often goes unrecognized, unreported, and untreated.

Risk Factors for Alcohol Misuse in the Elderly

Alcohol affects you differently as you age. While heavy drinking and alcohol use disorders tend to be less common in individuals aged 65 and older compared to other age groups, rates have increased in recent years. A 2021 analysis of national survey data estimated that 1 in 20 adults aged 65 or older had an alcohol use disorder in the past year.³ In part, that’s because the effects that alcohol has on the body and mind can change as you age. Older individuals tend to have an increased sensitivity to alcohol, which can raise their risk for many health problems, including injuries, dehydration, memory problems, liver disease, sleep problems, and overall mortality. Additionally, older adults are more likely than their younger counterparts to take medications, many of which can interact negatively with alcohol, causing potentially dangerous effects.⁷

Increased Sensitivity to Alcohol

People may become more sensitive to the effects of alcohol as they age for a number of reasons. As people age, they experience reduced activity of an enzyme that breaks down alcohol. Declines in the activity of this enzyme—called alcohol dehydrogenase—can lead to relatively increased levels of alcohol in the bloodstream over a longer time.⁸ At the same time, the decline of lean body mass in older adults could result in higher peak blood concentrations of alcohol than younger people might experience after consuming only a few drinks.²

Older adults may be more likely to experience impaired balance after drinking, which can increase the likelihood of falls or other accidents.²

Dehydration

Older adults may be at particular risk of dehydration. This is, in part, because as people age, the sense of thirst diminishes, renal function declines, body mass changes, and the balance of water and sodium in the body shifts.⁹ One study that looked at the correlation between dehydration and falls among the elderly population found that nearly 38% of the more than 30,000 participants were dehydrated.¹⁰ Another study discovered roughly 4 in 10 older adults admitted into hospitals show signs of dehydration.¹¹ Potentially compounding these issues is the fact that alcohol can result in more frequent urination, which in turn, can lead to dehydration.⁹

Increased Health Problems

Heavy drinking can exacerbate other health issues  that older adults commonly experience. Health conditions made potentially worse with heavy drinking include:¹²

• Diabetes.
• High blood pressure.
• Congestive heart failure.
• Liver problems.
• Osteoporosis.
• Memory problems.
• Mood disorders.

Bad Interactions with Medications

Many prescriptions, over-the-counter medications, and even some herbal remedies may not mix well with alcohol. In fact, when taken with alcohol, some medications can become dangerous or even deadly. Because so many older adults take medications (more than 90% of older adults, in fact)¹³ to manage chronic health conditions, one of the biggest health risks among seniors is the mixing of medications and alcohol. One study found that 1 in 5 older adult drinkers took medications that could have negative interactions with alcohol.¹³ Alcohol can render some medications ineffective, intensify certain side effects, and increase drug toxicity in some cases.¹⁴ Medications that can dangerously interact with alcohol include:¹⁴

• Aspirin.
• Acetaminophen.
• Cold and allergy medicine.
• Cough syrup.
• Sleeping pills.
• Pain medication.
• Mood stabilizers and anti-anxiety medications.
• Antidepressants and antipsychotics.
• Herbal remedies (such as kava kava, St. John’s wort, chamomile, valerian, and lavender).

Is It Safe for the Elderly to Drink Alcohol?

In aging adults, too much alcohol increases the risk of falls, accidents, car crashes, and other unintentional injuries.^15,16

Age plays a key factor in the risk of falls due to the physical, sensory, and cognitive changes that take place as a person gets older. Adults aged 60 and older suffer the greatest number of fatal falls.¹⁵ Nearly one-third of older adults who fall suffer moderate to severe injuries, including bruises, fractures, and head trauma.¹⁵ Alcohol increases the risk of falling because it can lead to balance problems, and studies show drinking increases the rate of hip fractures in older adults, too.¹⁶

According to the National Institute on Alcohol Abuse and Alcoholism (NIAAA), alcohol-related medical emergencies, resulting in visits to the ER, increased by 50% in the decade from 2006 to 2016, among older adults.¹⁷

Driving becomes riskier with age as well. Starting at age 55, the possibility of traffic accidents increases regardless of alcohol consumption. Drinking alcohol compounds the risk because it impacts reaction time, coordination, eye movement, and information processing abilities.¹⁶ One study, done in 2012, found that 21% of the drivers involved in fatal car crashes had a blood alcohol concentration (BAC) of 0.08 or higher. Of those, 14% of the drivers were aged 65 or older.⁶

Besides the increased safety concerns alcohol brings to adults aged 65 and older, it can cause numerous health problems, and increase the risks for and consequences of conditions such as diabetes, high blood pressure, congestive heart failure, liver and bone problems, memory issues and other neurological complications, and mood disorders, too.¹⁸ Alcohol use disorder may also contribute to bone problems and issues like osteoporosis (low bone density) in older adults.^18,19

Can Health Complications from Alcohol Be Reversed?

Regardless of age, alcohol can have a detrimental effect on all bodily organs, including the brain, cardiovascular system, liver, pancreas, and immune system.²⁰ Alcohol misuse can be a particular health concern for elderly, who may be more susceptible to specific health issues, such as heart disease, ulcers, liver problems, and bone disorders like osteoporosis.^18,21 The good news is that many alcohol-related health issues can improve when drinking stops. Through abstinence and proper treatment, better health and an improved quality of life can be achieved for many people.^19,22,23

Are Changes in the Brain Reversible?

Though some neurological issues associated with alcohol can improve when drinking stops, other types of damage to the brain may be more lasting. According to the NIAAA, the extent of alcohol-related damage to the brain and whether it can be reversed depends on different factors, including how much, how often, and for how long alcohol was consumed, and the individual’s overall health.²³

A particular type of alcohol-related brain damage, known as Wernicke-Korsakoff syndrome (WKS), develops when the body is deficient in thiamine. Eighty percent of people who misuse alcohol are thiamine deficient. WKS consists of two separate syndromes: One is a temporary and severe condition known as Wernicke’s encephalopathy. The condition includes confusion, optical nerve paralysis, and muscle coordination problems. The second is a persistent and disabling condition known as Korsakoff’s psychosis. It results in long-term learning and memory problems.²³ WKS may be reversible, especially if the individual receives early treatment, but if the condition becomes more severe, it’s possible to suffer from permanent brain damage and require custodial care.²³

Are Cardiovascular Changes Reversible?

Excessive alcohol consumption damages the heart and negatively impacts the cardiovascular system. Chronic drinking increases the risk of heart disease and death.²⁴ Some cardiovascular problems associated with alcohol misuse include: ^23,24,25

• Alcoholic cardiomyopathy.
• Cardiac hypertrophy (enlarged heart).
• Cardiac fibrosis.
• Cardiac arrhythmias.
• Tachycardia (rapid heartbeat).
• Hypertension (high blood pressure).

While some cardiovascular changes could be permanent, the heart is an adaptable organ that responds to and heals from many toxins, including moderate alcohol consumption. Some changes may be reversible when drinking stops—or is substantially reduced.²⁵

For example, one clinical review reported that people with alcohol-related cardiomyopathy, who abstained from drinking or cut back drinking, demonstrated “major improvement” in cardiovascular functioning.²⁵ Furthermore, research indicates that people with alcohol-related cardiac hypertrophy (a potential precursor to heart damage), who receive proper medical treatment, may be able to prevent or reverse the condition.²⁵

Is Alcohol-Induced Liver Damage Reversible?

The liver is the organ that is primarily responsible for metabolizing alcohol. Chronic or heavy alcohol use can lead to a range of liver diseases, including fatty liver (steatosis), alcoholic steatohepatitis (ASH), cirrhosis, and liver cancer.²²

Depending on the extent of the damage, some types of liver damage may be reversible. Abstinence allows the liver to recover from alcohol damage.²²  In fact, abstaining from alcohol for 2 to 3 weeks may completely resolve hepatic steatosis. One study asked heavy drinkers with ASH to abstain from alcohol consumption. After one month, certain enzymes in ASH returned to baseline levels, insulin resistance decreased, and blood pressure and cholesterol levels reduced in these participants.²² Quitting drinking also improves survival rates for people with other forms of alcohol-related liver disease, such as cirrhosis.²²

Are Ulcers Caused by Alcohol Abuse Curable?

When alcohol irritates the gastrointestinal tract (GI), it can lead to alcoholic gastritis—or alcohol-induced stomach inflammation, which could potentially progress to other GI issues such as ulcers and even stomach cancer.^26,27,28 Certain medications and abstinence help heal stomach ulcers and prevent them from worsening.²⁹

Is Osteoporosis From Alcohol Reversible?

Alcohol can negatively impact overall bone health. Alcohol can disrupt normal endocrine system functioning, resulting in calcium imbalances, affecting the body’s production of vitamin D, and disturbing estrogen levels—all of which can lead to osteoporosis and other bone-density issues. Abstinence can at least partially reverse alcohol-induced bone loss and consequently lead to a quick recovery in bone-building activity.¹⁹

Can Alcohol Cause Aging?

While there’s no hard evidence that proves alcohol causes premature aging, there are some indications that suggest alcohol’s role in creating visible signs of aging. For instance, the American Academy of Dermatology Association points to genetics as well as environmental and lifestyle choices, such as the consumption of alcohol, as causes for the premature aging of skin.³⁰

In addition, in a study that began in 1976 (when participants were 20) and followed them until 2003, researchers discovered that women who drank 28 or more alcoholic beverages per week were 33% more likely to develop arcus senilis, a gray or white arc above or below the outer part of the cornea, a condition common in adults over the age of 50. Thirty-five percent of men, who consumed more than 35 drinks per week, developed the condition as well.³¹

Other evidence of alcohol-related signs of aging is mostly anecdotal and includes stories of alcohol leading to wrinkles and inflammation. Skin, however, does have the ability to bounce back (for the most part), depending on the length of the heavy drinking. Giving up alcohol may allow the skin to begin regeneration.

Signs That an Elderly Person Is Misusing Alcohol

Drinking problems in elderly people often go unnoticed or unidentified. Because advancing age affects how the body processes alcohol, the same amount of alcohol can have greater intoxicating effects on a person over time, even if they never change the amount of alcohol they consume. The ensuing signs, including confusion, forgetfulness, or poor self-care, could be mistaken as signs of aging or side effects of medications they take.

Furthermore, older adults don’t always disclose truthful alcohol consumption to their physicians, so doctors may miss screening them for substance misuse.³²

While some signs can appear for other reasons, some warning signs of problematic drinking in elderly people may include:²

• Cognitive decline.
• Neglecting self-care.
• Missing medical appointments.
• Neglect of or non-adherence with recommended medical treatment.
• Uncontrolled hypertension.
• Recurring falls or accidents.
• Frequent visits to the ER.
• GI problems.
• Unexpected delirium during any hospitalizations (i.e., alcohol withdrawal delirium)
• Family estrangement.
• Laboratory findings that indicate alcohol misuse.

How Can I Convince an Elderly Friend or Family Member to Seek Treatment?

While you can’t force someone with a drinking problem to get help, you can communicate your concern to a loved one with support and compassion. Talk to them and let them know that you’re worried about their drinking and the impact it has on their health and well-being. Share facts and information from this article about the effects of alcohol on older adults. Encourage them to talk to their doctor about their alcohol use and offer to help them find treatment.³³

It can be stressful when a loved one has a problem with alcohol. Remember to practice self-care and prioritize your needs. Seek support from others and consider getting help for yourself. Attend a support group like Al-Anon, which is designed for the friends and family of people with alcohol problems, or seek out individual counseling. The most important thing to remember is that you’re not alone and help is available to support both you and your elderly family member or friend.

Alcohol Rehab for Seniors and the Elderly

There are many alcohol-related programs specifically designed for seniors. It might benefit older adults to be in a treatment program with peers or others in similar life stages since their reasons for drinking may differ from someone in a younger demographic. Some treatment centers offer programs that are age- or gender-specific.

Treatment options vary by facility and needed. Options include:

• Education and support services.
• Medical detox for alcohol withdrawal management.
• Inpatient alcohol treatment.
• Outpatient treatment.

Because older adults have higher rates of prescription drug use, it’s important that family members and their healthcare providers work together, check in, pay attention, and intervene when they suspect a problem. If you are an older adult struggling with alcohol misuse or addiction, or if you love someone who does, call American Addiction Centers (AAC) at . Talk to one of our compassionate and knowledgeable admissions navigators, who can answer your questions, talk you through the evidence-based interventions utilized at our facilities, and help you get yourself or your loved one on the path to recovery.