CONTENTS

Table of Contents
Introduction

1. Overview
2. Recognizing Alcohol Misuse and Abuse in Older Adults
3. Alcohol and Aging
4. Diagnosing Alcohol Problems in Older Adults
5. Recognizing Other Forms of Substance Abuse
6. Prevention and Early Intervention Strategies
7. Treatment
8. Outcomes and Cost Issues in Alcohol Treatment for Older Adults
9. Legal and Ethical Issues

Supplements
Resources

At Any Age, It Does Matter:
Substance Abuse and Older Adults (for Professionals)

“Healthy Drinking” Debate

Recent studies have shown that alcohol may protect against certain diseases, such as heart attack and stroke. These studies have focused on moderate wine drinking (one drink per day for women and two drinks per day for men).

The possible protective effect of alcohol may diminish when it is consumed in other forms, such as beer or hard liquor, or in higher amounts. Although moderate drinking may be beneficial among persons who already drink, nondrinkers should not begin drinking to reap possible health benefits. Nor should persons with chronic illnesses such as Alzheimer’s, diabetes, and hypertension.

Heart Disease

Some studies show that low levels of alcohol consumption (one standard drink per day or less) reduce the risk of coronary heart disease.³ “An intriguing epidemiologic finding is the association of regular, but moderate, alcohol use (up to two drinks per day) with lower morbidity and mortality from coronary artery disease,” compared with heavy alcohol users and abstainers. This finding is especially true in men.⁴

“This ‘U’ or ‘J’ shaped relationship appears to be quite robust,” occurring in diverse cultural and national cohorts.⁴ However, this benefit may not apply to adults already diagnosed with heart disease. Older adults in this category should not drink unless their physician says otherwise.

The New Mexico Elder Health Survey found that the relative risk (RR) of coronary heart disease (CHD) was inversely associated with alcohol consumption.⁵ The risk was cut in half (odds ratio, .46). Further, the type of alcoholic beverage was not associated with the prevalence of CHD. A literature review indicated a U-shaped relationship between CHD and regular alcohol use.

Many studies have suggested that alcohol lowers disease risk by increasing levels of high-density lipoprotein (HDL) cholesterol. HDL is the so-called “good cholesterol” that removes cholesterol from blood vessels. Other explanations include associated diet changes in moderate drinkers, decreased platelet aggregation and coagulation, and the ability to lessen stress and alter personality patterns associated with CHD risks.⁶

Other analyses of abstainer groups report conflicting findings.^3,7 Further study is needed on the relationship between alcohol and a rise in HDLs.^8,9 Possible antioxidant effects of beverage alcohol¹⁰ also merit attention.

Women’s Health

Although moderate alcohol consumption has been shown to improve HDL levels in women,¹¹ it also has been linked to breast cancer in postmenopausal women.¹² More studies on the risks and benefits of alcohol consumption for older women are needed to clarify this issue.

It has also been suggested that alcohol consumption may have a protective effect on bone density in women aged 75 years and older. Compared with nonusers, women who drank 11-29 g/day of alcohol (one or two standard drinks) had higher bone mineral density values at the trochanteric (hip) site. Neither 1-10 g/day (less than one standard drink) nor >30 g/day (more than two standard drinks) users had increased bone mineral density levels.

These results were unrelated to other factors such as estrogen replacement therapy, dietary calcium intake, or usual physical activity. Total body bone mineral density was lower in subjects with alcohol intakes >30 g/day.

The findings suggest that moderate drinking (one or two glasses of wine per day) can increase trochanteric bone mineral density in older ambulatory women. However, higher intakes may have harmful effects on bone mass.¹³

Stroke

Recently, the Copenhagen City Heart Study found indications of a U-shaped relationship between intake of alcohol and risk of stroke. Intake of wine on a monthly, weekly, or daily basis was associated with a lower risk of stroke compared with no wine intake (monthly: RR, 0.83; weekly: RR, 0.59; daily: RR, 0.70). There was no association between intake of beer or spirits and risk of stroke. These findings suggest that compounds in the wine in addition to ethanol are responsible for the protective effect on risk of stroke.¹⁴

Moderate alcohol consumption can affect the risk of certain types of stroke. Although moderate consumption decreases the risk of strokes caused by blocked blood vessels, it can increase the risk of strokes caused by bleeding.¹⁵

Socialization

Low levels of alcohol consumption also appear to promote and facilitate socialization among older adults, suggesting that alcohol plays an important role in their community life.¹⁶ Use of small amounts of alcohol in elder residential-care facilities can enhance resident socialization and morale. However, because the health of some older adults may be compromised by any alcohol consumption, recommendations for use should always be individualized.