How the risks of drinking increase in older age
Alcohol can present new problems in older age — particularly at 65 and older — for even light or occasional drinkers. Older adults tend to have less muscle mass and retain less water in their tissues compared with younger people, which can increase blood alcohol concentration, said Aaron White, a senior adviser at the National Institute on Alcohol Abuse and Alcoholism. This means it takes fewer drinks for older people to feel intoxicated, and heightens the risk of severe injury from falls.
According to Nixon's research, older people also show deficits in working memory at lower blood alcohol concentrations than younger drinkers. In another study Nixon worked on, some older adults in driving simulations showed signs of impairment after less than one drink.
Drinking alcohol can increase the risk of developing chronic conditions such as dementia, diabetes, cancer, hypertension and heart disease. But it can also worsen outcomes for the majority of older adults already living with chronic disease, said Aryn Phillips, an assistant professor of health policy and administration at the University of Illinois Chicago who studies alcohol and aging.
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Drug interactions also come into play. Mixing alcohol with prescription medicines that older adults commonly take, such as those for treating diabetes or hypertension, can make the medications less effective or cause harmful side effects, like ulcers or an irregular heart beat. Benzodiazepines, when combined with alcohol, can slow breathing and act as a powerful sedative. Even over-the-counter medication can be dangerous. Aspirin, which some older people take to reduce cardiovascular disease risk (despite the potential side effects), can lead to severe gastrointestinal bleeding, which older people are already at higher risk for, said Michael Wheeler, a professor of nutrition science at East Carolina University who researches alcohol-induced liver disease.
Some older adults also contend that hangovers worsen with age. While there's no strong scientific evidence supporting this, the hangovers may seem worse because alcohol can exacerbate other symptoms of aging, like poor sleep, White said.
How to Reduce Your Risk
Experts said alcohol use among older adults appears to have risen in recent years, though national trends are difficult to track outside of self-reported surveys. A federal survey from 2023 found that 12% of adults 65 and older — about 7 million people — reported drinking at least four or five drinks in a sitting in the previous month.
After decades of mixed messaging around alcohol's health harms and benefits, recent studies have made it clear that no amount of alcohol is good for you. Still, Sacco acknowledged that 'drinking has meaning for people,' and whether to moderate or quit altogether 'is a call that you have to make in consultation with your doctor and your loved ones.'
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But what is a 'safe' amount of drinking for the older set? That's difficult to say. The available studies attempting to establish exactly how much alcohol it takes to drive up health risks in older populations use different benchmarks for moderate drinking, making it tricky to draw a consensus. 'Even as an expert in this field, I understand the confusion,' Wheeler said.
Nixon advised that adults 65 and older should consume no more than one drink per day and no more than seven per week. (The NIAAA does not establish guidelines around alcohol consumption, but the Centers for Disease Control and Prevention defines moderate drinking for adults of all ages as two drinks or less per day for men, and one drink or less per day for women.)
All the experts emphasized that older people should pay close attention to their bodies' response to alcohol, and to stop drinking or cut back if they feel like it's affecting them more physically or cognitively.
'If you're not currently drinking, don't start,' Phillips said. And if you do drink, be honest with your doctor about your consumption, and do it in a safe environment, knowing that your tolerance may not be what it used to be, she added.
'The answer doesn't have to be abstinence,' Nixon said. But healthy aging 'probably does not include multiple drinks a day for most people.'
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