Alcohol and Older Adults: Did You Know Your Health Might Be At High-Risk?
By: Carol D'Agostino
Published and reviewed June 2009
Jim is 58 years old and was retired three years when he had a heart attack. Jim's father was in his mid-sixties when he died from a massive heart attack. Jim's experience left him not only with some heart damage but also a tremendous fear of dying young like his father. He's been doing everything his doctor has suggested to keep his blood pressure under control and improve his overall health. He's rearranged his diet, exercises daily, and takes his prescription medications faithfully. One of his medications is Coumadin, a blood thinner, which requires constant blood tests in order to maintain a correct level. One issue, however, that he and his doctor have not focused on is the fact that Jim drinks one Manhattan before dinner almost daily – and has for years.
Did you know that Jim's Manhattan could cause his Coumadin to thin the blood too much, interfering with clotting.
Did you know that a Manhattan isn't really considered one drink in the realm of national alcohol guidelines? A Manhattan can consist of anywhere between 3-4 shots of whiskey. Guidelines show that one serving of alcohol is considered to be 1.5 ounces (5 oz. for wine). Jim's Manhattan before dinner actually equals 2-3 "drinks" depending on how strong he makes it. Multiply that by seven days a week and that could be more than 14-21 drinks weekly-not the 7 that Jim would normally have believed.
Jim is at high-risk for further health complications.
Yvonne is 61 years old and has been caring for her 84 year old mother who has Alzheimer's disease. As a stressed caregiver, Yvonne is suffering from depression for the first time in her life. Her doctor prescribed an antidepressant over a month ago but Yvonne really isn't feeling much better yet. Her doctor is thinking about sending her to a psychiatrist to evaluate her depression even further – or possibly trying her on another antidepressant along with a sleep aid at bedtime. The one issue that Yvonne has not discussed with her doctor is the fact that she drinks 2 glasses of wine after dinner to "unwind" and to help her sleep. She's also heard that red wine keeps your heart healthy and might also ward off Alzheimer's disease.
Did you know that alcohol is a depressant?
Did you know that her daily use of wine can cause a decrease in the ability for Yvonne's antidepressant to function and that it can cause blood pressure problems?
Did you know that using alcohol to help you sleep can actually cause sleep to be interrupted and that breathing and blood pressure problems can occur?
Yvonne is at high-risk for her mental and physical health.
Jim and Yvonne are only two examples of older adults who are not aware of the impact of their "social drinking." They are considered to be misusing alcohol as their use puts them at high risk for other health crises. Like the majority of older (and younger!) adults, they will likely not adhere to the bright orange labels on prescription medication bottles warning them not to use alcohol. They never think to discuss their alcohol use with their doctors because they are not alcoholics nor are they abusing alcohol. They consider themselves to be "normal" drinkers and have many friends that drink much more than they do. Their doctors may not assess them for possible alcohol interactions and/or risks as they've known their patients for years. Jim and Yvonne are both responsible married adults, have raised families, have had successful careers and are doing their best to maintain a quality level of health in their retirement years.
As a Robert Wood Johnson Foundation Fellow (Developing Leadership in Reducing Substance Abuse Program) and former Director of Lifespan's Geriatric Addictions Program (G.A.P.), I have witnessed older adults suffering from devastating health effects from their at-risk alcohol use. I have heard conflicting messages to older adults with chronic disease from different healthcare professionals in regard to what they consider to be acceptable levels of drinking. I have read multiple articles in newspapers with conflicting information on what the proper type and amount of alcohol should be for older men and women. I have also noted that journal articles and research data point to a severe lack of quality screening tools for physician use – especially for older adults. Research from Columbia University even suggests that physicians do not feel adequately prepared to diagnose substance misuse in older adults – especially within the time constraints of managed care appointments.
So what are some educational highpoints that older adults and healthcare professionals need to know? *
- Chronic disease + prescription medication(s) + alcohol can be deadly for some older adults. Older adults do not have to be the proverbial "alcoholic" to be at high-risk with their alcohol use.
- Nothing about an older adult's drinking may have changed over the years but everything about their body and aging has. Chronic disease and the overall decline in an older adult's physical functioning can be exacerbated when alcohol is used. The combination can also place an older adult at high risk for falls.
- Abstain from alcohol if you're taking any antidepressant, pain, blood thinner, diabetic, arthritis, or cardiovascular drugs.
- Some over-the-counter and herbal medications mixed with alcohol can have dangerous effects.
- Consider one drink per day (1.5 oz. whiskey, 5 oz. wine) a prudent level of alcohol consumption if you have no medical contraindications and take no medications that interact with alcohol
- Consult a doctor or pharmacist about alcohol-drug interactions
In 2001, Lifespan of Greater Rochester, Inc. responded to the growing number of older adults in our community who are at high-risk for their alcohol and prescription medication use by launching the Geriatric Addictions Program (G.A.P.). This program provides a unique model through community outreach into client's homes. Professional intervention and education are provided to improve an older adult's health, safety and functioning. Lifespan's mission is to keep older adults living independently in the community for as long as possible. For G.A.P., this means not only the prevention of unnecessary medical crises and/or hospital admissions but also a halt in the progression of at-risk alcohol use that can lead to abuse or addiction. G.A.P. also provides geriatric care management which includes client linkage to other aging services within the community and family education.
G.A.P. has also begun working with older adults who have been diagnosed with some form of dementia to ensure that their alcohol and medication misuse does not cause further difficulty in mental functioning. With the Baby Boomers aging, G.A.P. unfortunately expects to see more older adults struggling with these issues.
G.A.P. has gained national, county and United Way recognition and was initially supported by The Daisy Marquis Jones and The Farish Foundations. In 2006, G.A.P. was the recipient of the American Society on Aging's "Healthcare and Aging Award for Innovative and Quality Programming for Older Adults." G.A.P. continues to provide ongoing education and training to healthcare professionals in our community and encourages the spread of important information on the dangers of mixing alcohol and prescription medications.
Requests for community educational presentations or referrals to Lifespan's Geriatric Addictions program can be made by calling (585) 244-8400, x184. Any suggestions/recommendations/concerns regarding G.A.P. can also be addressed to www.lifespan-roch.org.
* Adapted from education provided by Patrick Cullinane (American Society on Aging), and Patricia Bomba, M.D., F.A.C.P. (Vice President and Medical Director, Geriatrics, Excellus Blue Cross Blue Shield)
Carol D'Agostino is a Robert Wood Johnson Foundation Fellow for the Developing Leadership in Reducing Substance Abuse Program. She is a Board Certified Diplomate in Licensed Clinical Social Work and a New York State Certified Alcohol and Substance Abuse Counselor. Carol is currently a consultant for Lifespan's Geriatric Addictions Program and serves on several Monroe County older adult committees.
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