Alcohol Use in Older Adults

Chapter 15

Introduction

• “The French Paradox”– Benefits of red wine

• Contain substances that appear to prevent blood clots

• Prevents oxidation of low-density lipoproteins• Raises high-density lipoproteins

• Alcohol– Good for the heart and circulatory system– Protective against diabetes and gallstones

Introduction

• Heavy drinking– Major cause of preventable death

Alcohol and Alcohol Use Defined

• “Moderate” amount– When health benefits outweigh the risks– 1-2 drinks/day for men– 1 drink/day for women

• As a nutrient– Provides 7 Kcal/gram– A food, but not a nutrient– Not stored in body– Acts like a drug

Epidemiology

• Age• Geographic differences• Various alcohol related diseases causing death• Drinking patterns in older adults• Gender

– Men are two times more likely than women to drink excessively

– Women are more vulnerable to the consequences of alcohol use

Epidemiology

• Alcoholism Theories– Biogenetic model – Sociocultural model– Learning theory/behavior model– Psychological-psychodynamic model

• Genetics– First-degree relatives’ share genetic risk factors

Age-Related ChangesAffecting Alcohol Intake

• Physical changes– Body water to fat ratio decreases– Hepatic blood flow decreases– Liver enzymes diminish in efficiency– Increased permeability of blood-brain barrier

Nutritional Intake

• Alcohol adds calories without nutritional benefits

Risk Factors

• Age related problems and chronic health problems

• Physical changes– Less tolerant of alcohol

• Risks and benefits of alcohol consumption with aging

Alcohol, Physiology, and Pathophysiology

• Absorption begins in mouth and esophagus• Primary site of absorption is the small

intestine

Insel P, Turner RE, Ross D. Nutrition. 3rd ed. Sudbury, MA: Jones & Bartlett; 2007, p. 306. Reproduced with permission.

Alcohol, Physiology, and Pathophysiology

• Food delays rate of alcohol absorption• Alcohol metabolism occurs in liver

– Quick metabolism– Fatty liver

• Alcohol has a more serious damaging effect in women compared to men

• Alcohol stimulates appetite

Alcohol, Physiology, and Pathophysiology

• The Brain and Nervous System– Memory impairments can result– Facilitates dopamine transmission– Causes changes in brain’s normal activity– Decline in cognitive and physical function– Hepatic encephalopathy (brain disease)

Alcohol, Physiology, and Pathophysiology

• Vitamin and Nutrient Deficiencies– Decreases absorption of vitamins and minerals

Alcohol, Physiology, and Pathophysiology

• Vitamin and Nutrient Deficiencies

Alcohol and Malnutrition

Insel P, Turner RE, Ross D. Nutrition. 3rd ed. Sudbury, MA: Jones & Bartlett;2007, p. 319. Reproduced with permission.

Alcohol, Physiology, and Pathophysiology

• Vitamin and Nutrient Deficiencies– Thiamine

• Result = impairment of the brain and neurological system

• Risk of Wenicke-Korsakoff syndrome– Folic acid

• Alcohol blocks absorption of folic acid• Chronic alcohol abuse may result in

macrocytosis

Alcohol, Physiology, and Pathophysiology

• Vitamin and Nutrient Deficiencies (cont.)– Hormones

• Drinking one drink per day increases risk for breast cancer up to age 70

• Liver– Alcoholic liver disease

• Fatty liver• Alcoholic hepatitis• Cirrhosis

Alcohol, Physiology, and Pathophysiology

• Liver– Alcoholic liver disease

• Fatty liver• Alcoholic hepatitis• Cirrhosis

–Scarring of the liver–Potentially fatal– Increases the incidence of cancer of the liver

Alcohol, Physiology, and Pathophysiology

• Liver (cont.)– Alcohol-induced liver disease

• Degree of malnutrition correlates with liver complications

• Malnutrition is correlated with mortality• Obesity is a risk factor for alcoholic liver disease

– Alcoholic cirrhosis– Alcohol-induced liver injury

Alcohol, Physiology, and Pathophysiology

• Esophageal Cancer– Drinking alcohol is a risk factor

• Stomach– Alcohol use decreases the amount of alcohol

dehydrogenase– Gastritis is more common in heavy drinkers– Alcohol intake causes gastrointestinal bleeding

• Pancreas– Moderately increased risk of pancreatic cancer in

heavy drinkers

Alcohol, Physiology, and Pathophysiology

• Heart– Cardiomyopathy may occur with chronic alcohol

abuse– Genetics plays a role– Older adults are at particular risk

• Musculoskeletal– Chronic alcohol may cause development of

myopathy• More frequent falls and fractures

Alcohol, Physiology, and Pathophysiology

• Immune System– Alcohol abusers are often immunocompromised

• More infections• Poorer outcomes

• Cancers– Excessive alcohol intake linked to several cancers

• Sleep– Quality of sleep is fragmented

Drug and Alcohol Interactions

• Alcohol interacts with many over-the-counter drugs and medications

• Alcohol increases the potential hepatotoxicity of certain drugs

• Alcohol combined with diuretics may cause hypokalemic myopathy

Screening for Alcohol Dependence• CAGE screening tool

– Cut down, Annoyed, Guilty, Eye-opener– Identifies 60% to 70% of those who are alcohol

dependent• Alcohol Use Disorders Identification Test

– More indicative of problem drinking than the CAGE

• Michigan Alcoholism Screening Test• National Institute on Alcohol Abuse and

Alcoholism

Positive Effects of Alcoholin Older Adults

• Stimulates appetite• Improves digestion and promotes relaxation

Positive Effects of Alcoholin Older Adults

• Bone Mineral Density– Moderate alcohol intake in older women

associated with higher BMD

• Cardiovascular Benefits– Association of alcohol intake and decreased

cardiovascular problems in men– Alcohol consumption has an inverse correlation

with renal dysfunction

Positive Effects of Alcoholin Older Adults

• Dementia– European studies demonstrate lower risk of

dementia with moderate alcohol intake– Increasing evidence shows that moderate intake

of alcohol improves cognitive function, psychological well-being, and improved quality of life of elderly people

Positive Effects of Alcoholin Older Adults

• Recommendations– Whether to

consume alcohol for medical purposes is a balancing act

– Similar benefits can accrue from exercise and a healthier diet

© Gualberto Becerra/ShutterStock, Inc.

Management of Alcohol Dependence

• Vitamins– 400 mg folic acid and/or a

multivitamin/multimineral supplement every day– Alcohol blocks absorption of folic acid– Alcohol lowers body’s magnesium levels

Management of Alcohol Dependence

• Medications– Not as effective in older adults as compared to

younger and middle-aged adults– Acamprosate

• Stabilizes the glutamate system in the brain– Topiramate

• Reduces dependence on the “rewarding” effects of alcohol

Management of Alcohol Dependence

• Nonpharmacologic Interventions: Therapy and Education– Older adults tend to respond well to treatment– Behavioral therapy

• Cognitive-behavioral therapy• Group and family therapy• Self-help group

– Alcoholics Anonymous• Model of helpful, positive partnering

– Teach use of healthy coping strategies

Conclusion

• The prevention of alcoholism begins with early teaching of the dangers of alcohol abuse, early recognition of risk factors for alcohol abuse, and early interventions

• Alcoholism can lead to social, functional, economic, psychological, and physiological consequences.