Opinion: Alcohol & Health

Risky Drinking among U.S. Seniors

Unhealthy use of alcohol by older adults is a serious problem. Older adults have greater sensitivity to alcohol and reduced tolerance. This results from factors including slower metabolism and changes in body composition as we age. Excessive drinking can worsen common medical conditions including congestive heart failure, diabetes, dementia, and depression, and increase risk of falls and other injuries. It can also impact illness self-management and treatment adherence. The potential for adverse interactions between alcohol and medications adds to the risk, especially since older adults may often take multiple medications.

But at the same time, research has found that moderate alcohol consumption may provide some health benefits, such as reduced risk of cardiovascular disease. Thus, alcohol use by seniors is a complex issue.

Nearly 1 in 10 seniors reported at-risk drinking in a U.S. nationally representative study of Medicare beneficiaries 65 or older, conducted by our research group at Brandeis University using data from the Medicare Current Beneficiary Survey. These at-risk drinking statistics are based on the quantity and pattern of drinking, not whether an individual met diagnostic criteria for disorders such as alcohol dependence. At-risk drinking was defined as exceeding National Institute on Alcohol Abuse and Alcoholism guidelines. These state that for healthy seniors aged 65 and older (and not taking prescribed medications with which alcohol would present a problem), risky drinking means more than 7 standard drinks per week or more than 3 standard drinks on any single day.

Risky drinking (and alcohol disorders) are often missed in older people. Important strategies for addressing the problem include raising awareness, physician advice to cut back, brief counseling, and specialized treatment and support if needed. It is essential to make a decision about drinking based on the specific risks and benefits that an older adult faces. This decision should be made in consultation with a physician. For seniors with certain health conditions or prescribed medications, lower limits or abstinence may be best.

Elizabeth Merrick, Ph.D.

Dr. Merrick is a senior scientist in the Institute for Behavioral Health at Brandeis University. Dr. Merrick has 20 years of experience conducting health services research. Her research includes a focus on mental health and substance abuse services, and the intersection between general medical and behavioral health issues.


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