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)

Aging-Related Changes in How Alcohol Affects the Body

As people age, their sensitivity to alcohol increases. Older adults become intoxicated more easily. Adults over the age of 65 are more likely to be affected by at least one chronic illness, many of which can make them more vulnerable to the negative effects of alcohol consumption.⁴

Metabolism

The liver can metabolize only a certain amount of alcohol per hour, regardless of the amount that has been consumed. The rate of alcohol metabolism depends, in part, on the amount of metabolizing enzymes in the liver. This varies among individuals, appears to have genetic determinants, and changes with increasing age. A person's BAL may be affected by his or her age, gender, physical condition, amount of food consumed, and any drugs or medication being taken.

Three age-related changes significantly affect the way an older person responds to alcohol:

• Decrease in body water
• Increased sensitivity and decreased tolerance to alcohol
• Decrease in the metabolism of alcohol in the gastrointestinal tract

As a person ages, the percent of body weight composed of water decreases. Thus, a given amount of alcohol (which is water soluble) results in a higher BAL and greater degree of intoxication than when the person was younger.

In general, after the consumption of one standard drink, the amount of alcohol in the drinker's blood peaks within 30 to 45 minutes. Alcohol is metabolized more slowly than it is absorbed. Since the metabolism of alcohol is slow, consumption needs to be controlled to prevent accumulation in the body, which leads to intoxication.

Controlling consumption is particularly important in older persons, since alcohol takes longer to metabolize than in younger persons. This decrease in metabolism is due to a decrease in the gastric alcohol dehydrogenase (ADH). With the stomach less actively involved in metabolism, an increased strain is also placed on the liver.⁵

Changes in Women

Older women face even greater risks from alcohol use than men. Because women have lower percentages of body weight composed of water, they are at greater risk for quicker intoxication. An additional factor contributing to the difference in BACs may be that women have lower activity of ADH in the stomach, causing a larger proportion of the ingested alcohol to reach the blood.

The combination of these factors may render women more vulnerable than men to alcohol-induced liver and heart damage. Research suggests that women are also more vulnerable than men to alcohol-related trauma and legal and interpersonal difficulties.

Alcohol-Drug Interactions

Of the drugs most commonly used by older people, many have the potential to interact adversely with alcohol. The absorption, distribution, metabolism, and effects of drugs or alcohol may be affected. The major adverse clinical outcomes of drug-alcohol interactions are altered blood levels of the medication or alcohol, liver toxicity, gastrointestinal inflammation and bleeding, sedation and delirium, disulfiramlike reactions, and interference with the desired effect of medications.⁶

Older drinkers who take one or more drugs that place them at potential risk for negative drug-alcohol interactions represent about one-quarter of older alcohol users. However, they are often overlooked in estimating the extent of alcohol problems in older adults. By far, the most common risk is from the use of over-the-counter (OTC) pain medications and alcohol.⁷ For example, Tylenol (acetaminophen) carries the following warning:

If you generally drink 3 or more alcoholic beverages per day, check with your doctor about using Tylenol and other acetaminophen-containing products, and never take more than the recommended dosage. There is a possibility of damage to the liver when large amounts of alcohol and acetaminophen are combined.

To view alcohol interactions and side effects for a drug, click an option on the drug list. For more information on prescription and over-the-counter drugs, visit Intelihealth at www.intelihealth.com. Information on the alcohol content of various products may be found at the San Diego State University Driving Under the Influence Program site, What Is the Alcohol Content of Some Nonprescription Medications?, and at the Medline Plus Drug Information page.