Alcohol Use in Older Adults - Chapter 15
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- 1. Alcohol Use in Older AdultsChapter 15
2. Introduction The French Paradox Benefits of red wine Contain substances that appear to preventblood clots Prevents oxidation of low-density lipoproteins Raises high-density lipoproteins Alcohol Good for the heart and circulatory system Protective against diabetes and gallstones 3. Introduction Heavy drinking Major cause of preventable death 4. 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 5. Epidemiology Age Geographic differences Various alcohol related diseases causing death Drinking patterns in older adults Gender Men are two times more likely than women todrink excessively Women are more vulnerable to the consequencesof alcohol use 6. Epidemiology Alcoholism Theories Biogenetic model Sociocultural model Learning theory/behavior model Psychological-psychodynamic model Genetics First-degree relatives share genetic risk factors 7. 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 8. Nutritional Intake Alcohol adds calories without nutritionalbenefits 9. Risk Factors Age related problems and chronic healthproblems Physical changes Less tolerant of alcohol Risks and benefits of alcohol consumptionwith aging 10. Alcohol, Physiology, andPathophysiology Absorption begins in mouth and esophagus Primary site of absorption is the smallintestineInsel P, Turner RE, Ross D. Nutrition. 3rd ed.Sudbury, MA: Jones & Bartlett; 2007, p. 306.Reproduced with permission. 11. Alcohol, Physiology, andPathophysiology Food delays rate of alcohol absorption Alcohol metabolism occurs in liver Quick metabolism Fatty liver Alcohol has a more serious damaging effect inwomen compared to men Alcohol stimulates appetite 12. Alcohol, Physiology, andPathophysiology The Brain and Nervous System Memory impairments can result Facilitates dopamine transmission Causes changes in brains normal activity Decline in cognitive and physical function Hepatic encephalopathy (brain disease) 13. Alcohol, Physiology, andPathophysiology Vitamin and Nutrient Deficiencies Decreases absorption of vitamins and minerals 14. Alcohol, Physiology, andPathophysiology Vitamin and Nutrient DeficienciesAlcohol and MalnutritionInsel P, Turner RE, Ross D. Nutrition.3rd ed. Sudbury, MA: Jones & Bartlett;2007, p. 319. Reproduced withpermission. 15. Alcohol, Physiology, andPathophysiology Vitamin and Nutrient Deficiencies Thiamine Result = impairment of the brain andneurological system Risk of Wenicke-Korsakoff syndrome Folic acid Alcohol blocks absorption of folic acid Chronic alcohol abuse may result inmacrocytosis 16. Alcohol, Physiology, andPathophysiology Vitamin and Nutrient Deficiencies (cont.) Hormones Drinking one drink per day increases risk forbreast cancer up to age 70 Liver Alcoholic liver disease Fatty liver Alcoholic hepatitis Cirrhosis 17. Alcohol, Physiology, andPathophysiology Liver Alcoholic liver disease Fatty liver Alcoholic hepatitis CirrhosisScarring of the liverPotentially fatalIncreases the incidence of cancer of the liver 18. Alcohol, Physiology, andPathophysiology Liver (cont.) Alcohol-induced liver disease Degree of malnutrition correlates with livercomplications Malnutrition is correlated with mortality Obesity is a risk factor for alcoholic liver disease Alcoholic cirrhosis Alcohol-induced liver injury 19. Alcohol, Physiology, andPathophysiology Esophageal Cancer Drinking alcohol is a risk factor Stomach Alcohol use decreases the amount of alcoholdehydrogenase Gastritis is more common in heavy drinkers Alcohol intake causes gastrointestinal bleeding Pancreas Moderately increased risk of pancreatic cancer inheavy drinkers 20. Alcohol, Physiology, andPathophysiology Heart Cardiomyopathy may occur with chronic alcoholabuse Genetics plays a role Older adults are at particular risk Musculoskeletal Chronic alcohol may cause development ofmyopathy More frequent falls and fractures 21. Alcohol, Physiology, andPathophysiology 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 22. Drug and Alcohol Interactions Alcohol interacts with many over-the-counterdrugs and medications Alcohol increases the potential hepatotoxicityof certain drugs Alcohol combined with diuretics may causehypokalemic myopathy 23. Screening for Alcohol Dependence CAGE screening tool Cut down, Annoyed, Guilty, Eye-opener Identifies 60% to 70% of those who are alcoholdependent Alcohol Use Disorders Identification Test More indicative of problem drinking than theCAGE Michigan Alcoholism Screening Test National Institute on Alcohol Abuse andAlcoholism 24. Positive Effects of Alcoholin Older Adults Stimulates appetite Improves digestion and promotes relaxation 25. Positive Effects of Alcoholin Older Adults Bone Mineral Density Moderate alcohol intake in older womenassociated with higher BMD Cardiovascular Benefits Association of alcohol intake and decreasedcardiovascular problems in men Alcohol consumption has an inverse correlationwith renal dysfunction 26. Positive Effects of Alcoholin Older Adults Dementia European studies demonstrate lower risk ofdementia with moderate alcohol intake Increasing evidence shows that moderate intakeof alcohol improves cognitive function,psychological well-being, and improved quality oflife of elderly people 27. Positive Effects of Alcoholin Older Adults Recommendations Whether toconsume alcoholfor medicalpurposes is abalancing act Similar benefitscan accrue fromexercise and ahealthier diet Gualberto Becerra/ShutterStock, Inc. 28. Management of Alcohol Dependence Vitamins 400 mg folic acid and/or amultivitamin/multimineral supplement every day Alcohol blocks absorption of folic acid Alcohol lowers bodys magnesium levels 29. Management of Alcohol Dependence Medications Not as effective in older adults as compared toyounger and middle-aged adults Acamprosate Stabilizes the glutamate system in the brain Topiramate Reduces dependence on the rewardingeffects of alcohol 30. Management of Alcohol Dependence Nonpharmacologic Interventions: Therapy andEducation 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 31. Conclusion The prevention of alcoholism begins withearly teaching of the dangers of alcohol abuse,early recognition of risk factors for alcoholabuse, and early interventions Alcoholism can lead to social, functional,economic, psychological, and physiologicalconsequences.