To Drink or Not to Drink
You’re dining with good friends at a nice French restaurant, and the waiter proffers a wine list. Must you decline and cheerfully order ginger ale?
Not necessarily, says Alison A. Moore, MD, MPH, Professor of Medicine and Psychiatry, David Geffen School of Medicine at UCLA Division of Geriatrics. Alcohol offers a host of benefits for people over 65, including lowering the risk for diabetes, stroke, and diseases such as dementia that are related to the cardiovascular system. But it can also have significant risks.
The secret is being familiar with both
First, consider the possible benefits. Moderate consumption of alcohol may reduce the risk of heart disease by 30 to 40 percent. Alcohol reduces platelet aggregation and increases fibrinolysis, two actions which help break up existing blood clots and prevent new ones. For an individual who’s had a stroke, alcohol may help prevent a second stroke. All of this occurs with moderate consumption only, meaning half a drink or one drink on most days. Wine, beer or liquor—it’s your choice.
Alcohol is like any other substance or drug you use,” says Dr. Moore. “It depends on how often and how much you use that defines the risk and the benefits.”
WHAT YOU SHOULD KNOW
➢ While moderate alcohol consumption may provide some health benefits, excessive drinking can harm memory, blood pressure, liver function and other aspects of physical and mental health.
➢ As you age, it takes less alcohol than it did years ago to become impaired.
➢ Alcohol consumed late at night can interfere with sleep, which in turn can lead to multiple health problems.
Alcohol and aging
It also affects people differently as they age. “As we age, we get higher blood alcohol levels per amount consumed,” Dr. Moore adds. It isn’t a change in metabolism but rather a change in distribution. Alcohol is water soluble and is distributed throughout the body’s water compartment. With age, bodies have more fat and less total water, so individuals will have a higher blood alcohol level per dose consumed.
“If you give two drinks to a 30-year-old and two to an 80-year-old, in terms of blood alcohol level, it’s the equivalent of giving the 80- year-old three drinks,” she said.
Age also brings increased brain sensitivity to alcohol. Older people develop problems with coordination at lower levels of alcohol consumption than the young. It takes less alcohol to affect balance and to increase the risk for accidents. Many people cut down as they age just because they don’t like the woozy feeling.
Alcohol also interacts with many medicines commonly used by older adults. With some it’s a straightforward contraindication, meaning don’t mix them. This is especially true of medications that affect the brain, including antidepressants, narcotics, and sleeping pills. The effects of any of these can be magnified by alcohol. Even mixing it with sedating allergy pills can increase the risk for confusion and falls.
Alcohol can also increase the risk for gastrointestinal bleeding. Certain pain medicines, including aspirin, ibuprofen and other nonsteroidal anti-inflammatory drugs (NSAIDS) can also increase bleeding risk, so mixing them increases the risk. Blood thinners such as warfarin are also generally not to be mixed with alcohol. Gastrointestinal reflux disease (GERD), ulcer disease, and gout can all be made worse by alcohol.
Weigh the risks, benefits
Given the range of health benefits and potential complications, you should have a conversation with your doctor before you either accept or forgo that glass of wine. The good news is that people who drink moderately into older age are statistically in better health than those who stopped drinking. They tend to have healthier weight, exercise more, tend to be better educated, and have higher incomes. The only negative is that people who drink are also more likely to smoke.
“All that being said, no one is yet ready to advise people to start drinking in old age,” says Dr. Moore. “But if an individual doesn’t have medical or psychiatric conditions that could be complicated by alcohol, including an alcohol use disorder, and if they don’t take medications that can cause problems with alcohol, then drinking a drink or less a day can be safe,” she adds.
In older adults the recommended drinking limit for men and women is no more than about a drink a day. That is, no more than seven per week, and no more than three per occasion. That’s the official recommendation from the National Institute for Alcohol Abuse and Alcoholism. A drink is defined as 12 oz of beer, 4-6 oz of wine, or 1.5 oz of 80-proof spirits.
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