Alcohol problems in older adults

Coverage in the media may well give the impression that drinking too much alcohol is something that younger people do however surveys show that at least 1 in 5 older people are drinking at levels that may cause them harm. The risks include not only harm to health, such as high blood-pressure, diabetes, cancers and liver disease, but also noticeable day-to-day effects such as poor sleep, memory problems and anxiety. We have seen a worrying increase in alcohol-related hospital admissions and alcohol-related mental health problems for older adults.

Why do older people start drinking more?

A recent report by ILC- UK and Drink Wise, Age Well found that of those whose drinking had increased,  40% cited retirement as a contributing factor, along with bereavement, a loss of sense of purpose, fewer opportunities to socialise and financial worries. Drinking alcohol for many may be an enjoyable and relaxing experience, but for some, their alcohol use may start to have a more negative effect

What are the effects of alcohol on older people?

As we age, our bodies no longer process alcohol in the same way, so alcohol can have a stronger effect on older people, even when drinking small amounts.  For example, balance might be affected, increasing the risk of falls and injury.

Medication can mix negatively with any alcohol, leading to unpleasant short- and long-term effects

How can you tackle your older relative’s drinking?

However, this is an issue which still lies below the radar and there is a high level of stigma and shame attached to drinking too much, so people who may need help, might not ask for it. Worryingly too, for those who are at increased risk of harm from alcohol, it is unlikely that family members, friends or health professionals will raise the issue of their drinking.

As a son or daughter of an older parent whose drinking may concern you, it can be a very difficult conversation to start. Also, in some instances, the problem may be concealed or manifest as another health problem, e.g. memory issues.

So what are the warning signs to look out for?

• Are they declining social invitations and isolating themselves?
• Have they stopped doing activities they previously enjoyed?
• Sometimes you may observe changes in their home environment.
• Is the person’s appearance becoming more unkempt?
• Are there signs of empty bottles or overflowing bins?
• Or are they trying to conceal bottles and evidence of drinking?
• Are they becoming increasingly forgetful?
• Have they had more falls and injuries?
• Has their general demeanour changed?
• Do they appear to be under the influence of alcohol, with indications like smelling of alcohol and slurred speech?

It can sometimes be difficult even to start the conversation with a loved one about their alcohol use. However, if you try and reduce the stigma and try not to focus on the negative aspects of their behaviour, this may be more beneficial.

Avoid bringing up the subject of their drinking when they are under the influence of alcohol.  Look for more suitable opportunities, such as when they express regret, or talk about something bad that has happened when they have been drinking.

Try and start the conversation by explaining that you love and care for them. It is important that the person still feels ‘connected’ and a valued member of the family. Always avoid a confrontational style. If the person is continuing to deny their problem, or is rationalising their alcohol use, end the discussion and try again another time. In general, try and concentrate on their health and well-being rather than the actual alcohol use.

Questions to ask your older parent about their drinking

For example, some questions you could start with are:

• “I have noticed that you have not met your friends at the club for a while, has something changed for you recently?”
• “Is there something you are worrying about?”
• “You don’t seem to be sleeping so well recently. Do you know what could be causing this?”

If they are continuing to drink, there are some practical steps you can put in place:

• Make sure there are no loose wires to trip over and that walkways and stairs are de-cluttered
• Prompt them to turn off gas and electrical appliances before they start to drink
• Prepare food and ensure they have snacks, which are available and accessible
• Encourage them to take a shower or bath before they start drinking to prevent accidents
• Keep their house phone or mobile charged and within reach
• Encourage them to stay hydrated and where possible, eat when drinking
• Have medication dispensed in dosage boxes for easy monitoring of timing and correct dosage.
• Offer to visit their GP with them to discuss any worries or difficulties they may have
• Reassure them that you are not judging them, but only care about their health and well-being
• Include them in any social activity or plans, even if they are refusing to go. Keeping them involved will give them an important sense of worth and connection with you.

Of those older adults putting themselves at risk through their drinking, many may not even realise the harm they are doing. Alcohol units and government guidelines can be confusing, especially with the recent revisions and conflicting messages in the media*

What are safe drinking limits?

Alcohol and its effects vary from person to person, especially as we age. It’s important to remember that if you have health problems or use medications, including over the counter medicines, these can also affect how much you are able to drink.

The government recently set new alcohol guidelines. Guidelines for men and women are now the same. You should not regularly drink more than 14 units of alcohol per week (7 pints of lower strength beer or 6 medium size glass of wine (175 ml) )

• It is advised to spread the 14 units over at least three days of the week
• Try and have regular alcohol free days

Also to reduce the short-term health risks of drinking (i.e. falls, injuries), try and limit the amount you drink in one sitting by drinking slowly, drinking with food and regularly hydrating with water. No known level of drinking can be deemed to be fully safe (especially in terms of illnesses such as cancer) therefore we can only refer to ‘lower risk’ drinking.

For adults aged 65 and over , some health experts recommend that older adults should consume even less alcohol. This is because as we get older:

1. Muscle is replaced by body fat. Alcohol is not drawn into fat as well as muscle therefore BAC (blood alcohol concentration) is higher in older people
2. Our bodies ability to breakdown the alcohol in the liver is reduced
3. We become more sensitive to the toxic effects of alcohol
4. More likely to be on medications

However, there are currently no government guidelines on recommended limits for older adults and it is important to add that the health and well-being of older adults varies greatly for each individual.

Some ways to stay safer when drinking

• Keep track on the amount of units in drinks by using a pouring measuring
• Ensure you have a meal before or with your drink and Staying hydrated
• Have a number of alcohol free days during the week
• Find activities and hobbies which do not involve alcohol use

Benefits of reducing alcohol consumption in older adults

There are a lot of positives to reducing our alcohol use and many of these happen quite quickly. They include

• Sleeping better
• Much more energy
• Improved memory
• Less likely to fall
• Saving money
• Less calorie intake
• Better family relationships
• Improved mood
• Healthy and independent

* Current  DOH recommended guidelines state that men and women should not drink more than 14 units (6 pints of regular strength beer or 6 medium size glassed of wine units a week)  and spread these over at least three days

For more information on making healthier choices about alcohol as we age, go to DrinkWiseAgeWell