Dear Age Smart: “I’m a 63 year old woman in good health but come from a family in which alcoholism runs rampant. I don’t think I’ve ever had a problem with alcohol and I like my glass of wine with dinner. But I have some concern about the health effects of alcohol as I get older, especially given my family history. Do you think I should give up alcohol completely?” Cabernet Lover
Dear Cabernet Lover: This is Cliff. The National Institute on Alcohol and Alcoholism (NIAAA) recommends that people over 65, male or female, have no more than one drink per day. A “drink” in this case, is 12 ounces of beer (assuming 5% alcohol), 5 ounces of wine (assuming 12% alcohol) or 1.5 ounces of distilled spirits (e.g. vodka, rum, whisky, gin at 40% alcohol or “80 proof”). Some guidelines say one drink a day for women and two for men are compatible with good health outcomes, but this standard applies to younger adults and older men may not tolerate two drinks as well as younger men. You’re a 63 year old woman and either guideline applies in your case and both give the same recommendation: one drink should be the limit for adult women if they want to avoid health problems from alcohol. Of course, this assumes a person isn’t pregnant, in which case no amount of alcohol is safe. It also assumes that the person has a health condition or takes medications that are incompatible with alcohol. Health conditions such as diabetes, high blood pressure, liver disease, depression, anxiety disorders, insomnia or certain cancers should not drink. Older adults are at higher risk of falls, worsening obstructive sleep apnea, memory impairment and driving accidents for up to 12 hours after moderate drinking. The same amount of alcohol gives higher blood levels in older adults, takes longer to metabolize and has a larger effect on brain function in older adults. You’re not that old, Cab Lover, but these changes are gradual and sneak up on you.
That said, you probably know that light drinking in keeping with the one drink per day limit, has been associated with lower risks of heart attack and dementia. We don’t know for sure if this is a direct protective effect from alcohol, but there is evidence to support that conclusion. Plus, the enjoyment you get from your daily glass of wine is worth a lot too!
OK, fine. But that doesn’t answer your question. You have a family history of alcoholism, but never have had a problem with alcohol yourself. Many children of alcoholic parents can control their drinking and never have a trouble with alcohol, although many are susceptible to losing control of their drinking or suffering ill effects from even small amounts. At your age, with years of experience with safely controlling your intake, we can conclude that you have avoided the family genes for alcoholism, although you have probably suffered some consequences from being around others with the family disease. So, can you continue to have both one glass of wine with dinner and good health into old age? Yes. But that assumes you don’t have other health conditions or take medications that would contradict that. If you have any doubts, ask your primary care provider. What do you have to add, Len?
Cliff, I have to say that you have done a fine job, as I have come to expect, covering the physical and biological impacts of alcohol consumption and the complicating effects it can have on our bodies and health as we age. We should all take seriously all that you have said. Let me throw some additional ideas into the mix of possible interest for “Cabernet Lover” and so many others like her. In the name of full disclosure, I will offer my thoughts knowing that I enjoy a couple of glasses of wine most days of the week after the proverbial “5 o’clock whistle” blows.
Here’s the good news – fewer than 10% of men and women age 60 and over are “at risk” drinkers as defined by the National Institutes of Health (NIH). Low risk drinking is defined as no more than 14 drinks per week and no more than four drinks on any day within the week for men and no more than three drinks on a given day and seven in any week for women. Within these limits, NIH reports that about two in 100 people will have alcoholism or alcohol abuse. But take note, NIH also warns that men and women 65 and over should adhere to the three drinks on any day and seven per week limit.
As Cliff notes, social drinking in light to moderate amounts can be relaxing and even heart healthy. It can also improve your appetite, has been shown to be protective against type 2 diabetes, and is associated with better cognition and well-being when compared against those who abstain from alcohol use.
The bad news is that moving to that third drink daily for men and the second for women is associated with numerous negative health effects including the worsening of other health conditions, interfering with prescription drugs your taking, causing serious illness, and decreasing your overall quality of life not to mention the lives of those who care about you. I’ll add to Cliff’s list by noting the risks of heavy alcohol use include erectile function, hypertension, and dementia, sleep disorders, depression, stroke, and cancer, not to mention a higher risk of accidents, and dangerous behaviors (like unprotected sex).
And remember, just because you may be in the low risk category does not mean you are at no risk. If you drink too quickly, plan to drive, are taking medications that interact with alcohol, or have a medical condition that is worsened by drinking, even “low risk” drinking is ill advised.
Bottom line, the processes of aging inevitably change the way our bodies respond to alcohol (and a host of other drugs) and adds new risks associated with their use. Unfortunately, most of us are really quite uninformed of the additional health risks that arise when we consume alcohol on a regular basis in combination with certain medications we are taking. And, our trusted health care professionals more often than not don’t take the initiative to discuss these matters with us.
If you are concerned you have a problem, you can be sure you are not alone. The misuse and abuse of alcohol is on the rise especially among aging baby boomers. Unfortunately, we boomers have a history of higher substance use than previous generations of older adults. If you are questioning your alcohol use, consider taking one of the following two evidence-based screening tests used by professionals to assess for alcohol abuse: the CAGE Test or the Short Michigan Alcohol Screening Test (S-MAST) – Geriatric Version. Both are readily available on-line.
Two final thoughts – First, you know what they say – “everything in moderation” – good words to live by for sure, especially in later life. And second, don’t be timid or embarrassed to discuss your alcohol consumption habits with a health care professional – take the initiative and broach the issue – they likely won’t, so you should!