The Dangers of ‘Overage’ Drinking
Aging boomers, retirement boredom and a penchant for booze portend a perilous cocktail.
By Kimberly Leonard
May 13, 2015
An extra shot of bourbon. One more glass of chardonnay.
“Having another” can often go unnoticed or ignored when it’s an older adult who’s doing the drinking. After all, Grandpa’s lived a long life and shouldn’t be denied his own “cough medicine.”
But there’s growing concern – and research – that shows such an approach can be wrongheaded. In fact, as far back as 1998, the U.S. Substance Abuse and Mental Health Services Administration warned that alcohol and prescription drug problems among adults 60 and older were among the fastest-growing health issues facing the country, expressing worry about an “invisible epidemic” of substance abuse among seniors.
Still, much is unknown about the extent of such issues among the older population. Most currently available information about alcohol abuse, as well as public policy and medical research, focuses on teens and young adults.
“It’s definitely an area in need of more understanding,” says Dr. Alison Moore, a professor in the medicine and psychiatry departments at UCLA’s David Geffen School of Medicine.
Adding to the need for urgency is that a flood of baby boomers – who tend to drink more than their older predecessors, Moore says – has been turning 65 since 2011, and the 65-and-older population is projected to number 83 million by 2050. By 2020, according to a 2008 study, those boomers also will have helped to double the number of adults 50 or older with a substance abuse disorder, from 2.8 million in 2006 to 5.7 million.
The burgeoning number of boomers entering retirement and the adverse health effects of alcohol are likely to strain an already burdened U.S. health care system. In March, federal budget analysts estimated that the cost of Medicare – the government’s health insurance program for seniors – will reach $8.8 trillion by 2025, and many experts agree the program is in desperate need of reform to be sustainable.
“Even leaving aside the heavier drinking of baby boomers, the growing population of Americans over age 65 will be felt in emergency departments and inpatient hospital departments,” says Ellen Meara, an associate professor at The Dartmouth Institute for Health Policy and Clinical Practice.
Add in alcohol-related issues, and Meara says both emergency room visits and inpatient hospital admissions for patients 65 and older are expected to roughly double over 2012 levels, when there were 729,000 emergency department discharges among that age group for alcohol-related diagnoses and 72,000 admissions to inpatient hospital departments for the same types of conditions.
As people age, many of the long-term effects of alcohol use can take hold, exhibiting themselves in the form of liver disease, high blood pressure, heart attack, stroke and certain kinds of cancer. And while 10 to 15 percent of people start to drink heavily in old age, Moore says, the majority of those who imbibe excessively later in life have been drinking more than is good for them earlier in it.
“People have probably been drinking in this way for a long time,” she says. “As they age it’s riskier, because there is more medication and illness.”
The reasons for excessive drinking among older men and women, whose lives often change dramatically, can be fairly unique. Some, for example, may turn to alcohol to assuage grief after the death of a spouse or while struggling with loneliness; others may begin drinking regularly after retirement, dealing with boredom caused by emptier days.
“We live in a society that promotes the heavy use of alcohol, especially when it comes to stress,” says Dr. Nicholas Pace, a National Council on Alcoholism and Drug Dependence, Inc. board member and professor at the New York University School of Medicine. “‘If you want to relax, you should have a drink; if you want to sleep, you should have a drink’ – by the way, these are things you should not do.”
But identifying alcoholism – which psychiatrists now call alcohol use disorder – among older adults can be difficult. Moore says some of the current criteria put forward by the American Psychiatric Association for identifying alcohol use disorder aren’t relevant for older adults, and would only result in about 1 percent of women and 2 percent of men being diagnosed with the condition.
Meanwhile, 4 out of 5 seniors who seek treatment for substance abuse have a problem with alcohol and not drugs, according to the National Council on Alcoholism and Drug Dependence, Inc. And a study showed that 9 percent of community-dwelling Medicare beneficiaries age 65 and older – 16 percent of men and 4 percent of women – reported exceeding recommended drinking limits.
Experts say risky drinking for someone 65 or older is defined as consuming more than seven drinks a week or more than three drinks in a single day. Medical experts recommend that – just as with anyone legally able to drink – men limit their drinks to no more than two a day and women to no more than one a day.
“A lot of people aren’t informed that the amount they are drinking is unhealthy for them,” Moore says.
The stigma surrounding alcoholism also can pose hurdles to identifying and acknowledging a problem, Pace says, and doctors often do not detect a problem because they mistake the symptoms of alcohol abuse with dementia, diabetes or depression – all of which are common among older adults.
“It’s a disease of denial, and many times the doctor looks the other way,” Pace says.
The mixture of prescription drugs – also common among older people – and alcohol can prove particularly dangerous, putting a person at risk of internal bleeding and heart problems, among other conditions.
And though some families or their doctors may not think the issue is worth addressing with people late in their lives, Pace says there can be a dramatic change.
“I’ve seen people quit in their late 70s – they can do really well,” he says. “They are able to start to think better and clearer … I have seen people look 10 years younger.”
He concludes: “You don’t have to die from this disease.”