Alcohol Use in Older Adults - Chapter 15

31
Alcohol Use in Older Adults Chapter 15

description

“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

Transcript of Alcohol Use in Older Adults - Chapter 15

Page 1: Alcohol Use in Older Adults - Chapter 15

Alcohol Use in Older Adults

Chapter 15

Page 2: 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

Page 3: Alcohol Use in Older Adults - Chapter 15

Introduction

• Heavy drinking– Major cause of preventable death

Page 4: Alcohol Use in Older Adults - Chapter 15

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

Page 5: Alcohol Use in Older Adults - Chapter 15

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

Page 6: Alcohol Use in Older Adults - Chapter 15

Epidemiology

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

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

Page 7: Alcohol Use in Older Adults - Chapter 15

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

Page 8: Alcohol Use in Older Adults - Chapter 15

Nutritional Intake

• Alcohol adds calories without nutritional benefits

Page 9: Alcohol Use in Older Adults - Chapter 15

Risk Factors

• Age related problems and chronic health problems

• Physical changes– Less tolerant of alcohol

• Risks and benefits of alcohol consumption with aging

Page 10: Alcohol Use in Older Adults - Chapter 15

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.

Page 11: Alcohol Use in Older Adults - Chapter 15

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

Page 12: Alcohol Use in Older Adults - Chapter 15

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)

Page 13: Alcohol Use in Older Adults - Chapter 15

Alcohol, Physiology, and Pathophysiology

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

Page 14: Alcohol Use in Older Adults - Chapter 15

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.

Page 15: Alcohol Use in Older Adults - Chapter 15

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

Page 16: Alcohol Use in Older Adults - Chapter 15

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

Page 17: Alcohol Use in Older Adults - Chapter 15

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

Page 18: Alcohol Use in Older Adults - Chapter 15

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

Page 19: Alcohol Use in Older Adults - Chapter 15

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

Page 20: Alcohol Use in Older Adults - Chapter 15

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

Page 21: Alcohol Use in Older Adults - Chapter 15

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

Page 22: Alcohol Use in Older Adults - Chapter 15

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

Page 23: Alcohol Use in Older Adults - Chapter 15

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

Page 24: Alcohol Use in Older Adults - Chapter 15

Positive Effects of Alcoholin Older Adults

• Stimulates appetite• Improves digestion and promotes relaxation

Page 25: Alcohol Use in Older Adults - Chapter 15

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

Page 26: Alcohol Use in Older Adults - Chapter 15

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

Page 27: Alcohol Use in Older Adults - Chapter 15

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.

Page 28: Alcohol Use in Older Adults - Chapter 15

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

Page 29: Alcohol Use in Older Adults - Chapter 15

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

Page 30: Alcohol Use in Older Adults - Chapter 15

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

Page 31: Alcohol Use in Older Adults - Chapter 15

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.