You are currently viewing Aging and Alcohol: How to Identify Problem Drinking in Older Adults

Aging and Alcohol: How to Identify Problem Drinking in Older Adults

Episode #106June 7, 2024

Did you know that 65% of adults over 65 report high-risk drinking? Understanding the unique impacts of alcohol on aging bodies is crucial for all of us.


In this episode, I’ll walk you through three key considerations: increased sensitivity to alcohol, health complications, and harmful interactions with medications. We’ll also discuss common triggers for increased alcohol use and practical tips for caregivers and healthcare providers to help identify and manage problem drinking among older adults.


Episode Highlights:

  1. Increased Sensitivity to Alcohol:
    • As we age, our bodies become more sensitive to alcohol.
    • This means we experience its effects more quickly, putting us at a higher risk for falls, car accidents, and injuries.
  2. Health Complications:
    • Older adults often have health conditions like diabetes, heart disease, and osteoporosis that alcohol can make worse.
    • Heavy drinking can also lead to new health issues, such as liver disease and dementia.
  3. Medication Interactions:
    • Many older adults take medications that can interact dangerously with alcohol.
    • Even common over-the-counter meds can have harmful effects when mixed with alcohol.
  4. Triggers for Increased Alcohol Use:
    • Life changes like retirement, divorce, or the loss of a loved one can lead to more drinking.
    • Functional limitations and boredom can also contribute to increased alcohol use.
  5. Identifying Problem Drinking:
    • Signs of alcohol use disorders can look like other medical conditions.
    • The CAGE screening tool can help identify problem drinking in older adults.
  6. Effective Treatment:
    • Substance use treatment works, even for older adults.
    • Everyone deserves access to mental health care and support, no matter their age.


Practical Tips:

  • Be curious and open when discussing alcohol use with older adults.
  • Encourage them to be honest with their healthcare providers about their drinking.
  • Offer support and resources to help manage alcohol use and life transitions.



Final Thoughts:

Remember, you play a crucial role in supporting older adults. There’s no expiration date on healing and transformation. Every person, at every age, deserves access to mental health care. Let’s break the myths and get older folks the help they need.




About Dr. Regina Koepp

Dr. Regina Koepp is a board certified clinical psychologist, clinical geropsychologist, and founder and director of the Center for Mental Health & Aging: the “go to” place online for mental health and aging. Dr. Koepp has been featured in NY Times and NPR and is a sought after speaker on the topics of mental health and aging, caregiving, ageism, resilience, sexual health and aging, intimacy in the context of life altering Illness, and dementia and sexual expression. Learn more about Dr. Regina Koepp here.





About 65% of people, 65 and older report high risk drinking, high-risk drinking is defined as exceeding daily guidelines, at least weekly in the past year.

There are many ways that alcohol impacts older adults bodies differently than younger age groups. And I'm going to review three of those considerations. Now.

The first is that as we age, our bodies have increased sensitivity to alcohol. This means that our body's tolerance is lower

and that we generally experience the effects of alcohol more quickly than we did when we were younger.

This puts older adults at a higher risk of falls or car accidents and other unintentional injuries.

Also as we age, our bodies are more vulnerable to certain health conditions. And so when we have these health conditions as an older person, and then we drink on top of these health conditions, it can have a serious impact on our health and, make those problems worse.

So conditions like.

Diabetes. Ulcers. Stroke, heart disease. Liver problems, cancer memory problems, or dementia disorders. Depression, anxiety decreased bone density or osteoporosis. Heavy drinking can make these medical conditions worse.

Not to mention that even if we don't have those medical conditions to start heavy drinking can increase the risk for some very serious medical conditions and the near future, especially for older folks.

Drinking too much alcohol over a long period of time can also lead to medical problems like liver disease, cardiovascular disease, dementia disorders, osteoporosis, chronic pain, and a myriad of other medical conditions as well.

Finally the third consideration is that many older adults are taking medications. And when you interact alcohol with medication that can have very serious effects. And so the third consideration is harmful interaction effects between medications and alcohol.

Many medications can be hazardous or even deadly in some cases when mixed with alcohol. Even very common over the counter medications like aspirin and acetaminophen or cold an allergy medications can interact negatively with alcohol in an older body. And so I often recommend my older clients to be very honest with their prescriber or their physician about their alcohol use so that they can do some harm reduction related to harmful medication interactions.

What might trigger an older person to drink more heavily than they used to, or develop a problem with drinking? There are many conditions in older adulthood that can increase the risk for developing a substance use disorder- situations like a retirement or a divorce.

More older adults are divorcing than we've seen in history before. Also. The death of a spouse or a loved one changes like moving to a new community. Becoming diagnosed with a new medical condition, a loss of friends or connections that were once important to you, functional limitations, maybe you can't drive anymore.

So you rely on others and you find that you're stuck at home. And so bored. And that might increase the risk of drinking or substance use disorder. Maybe difficulty sleeping. I hear this from a lot of older adults that drinking helps me fall asleep, but the challenge with drinking is it's a good short term solution for going to sleep, but it's a horrible sleep aid because you wake up in the middle of the night and don't get good quality sleep.

And so there are many situations that can increase the risk for older adults. And this is where you really have an important role because you could be curious about these things. How are you doing navigating these transitions? And then maybe, provide some resources before it turns into problematic drinking.

So what's very tricky about older adults and drinking is that they actually call older adults who experience problematic drinking as the invisible population.

And that's because it can be really hard to detect alcohol use among older adults, because some of the signs and symptoms can be miss attributed to medical problems. And it can get very tricky to really identify if somebody does indeed have a substance use disorder.

So some of the signs and symptoms often mimic medical conditions like passing out or seizures or dizziness or falls. Unexplained bruising or skin tears. Memory problems or confusion, strain and relationships, sleep problems, mental health concerns. And so many of the signs and symptoms that are present with substance use disorders with older adults are so easy to attribute to something other than a substance use disorder. So it's really important that when you're noticing some of these signs and symptoms that we simply ask how often are you having a glass of wine or alcoholic beverage.

There's an alcohol screening tool that is used commonly with older adults called cage. It's an acronym, C A G E. The C stands for cut down. Have you ever felt that you needed to cut down on your drinking? Yes or no?

The a is for annoyed. Have people annoyed you by criticizing your drinking.

The G is for guilty. Have you ever felt guilty about your drinking?

And the E is eye opener. Have you ever felt that you needed an eye-opener first thing in the morning to help you calm your nerves?

And so if the person says yes to any of these, that's a good time to start the conversation about getting them connected with their primary care doctor to see if there might be other ways to support them In instead of substance use

there's a myth about aging that older adults are rigid and will never change. And I've heard from many providers, medical and mental health providers. Why would I refer this older person to treatment?

They're not going to change anyway,

That there are too rigid and won't change because older people don't change right? Wrong. What we know is that substance use treatment is highly effective for older adults. And there were even been studies that show that it's even more effective for older adults. So one study looked at older adults who engage in substance use treatment that was tailored for older adults and found that those older adults tended to have better outcomes in terms of sobriety even a year after treatment ended. This shows us that treatment can be effective and very beneficial for older adults.

And so what I would say is if you have some voice in your head saying, oh, I don't know if they're really gonna do it. Offer it anyway and let them be the one to reject the offer rather than you reject it by not offering it in the first place. And so don't buy into the belief that older adults are rigid and will never change, or that mental health or substance use treatment is not as effective.

That is incorrect and older adults deserve access, just like everybody else.

I'd like to end by saying that

you have a really important role in helping older adults to live their best quality of life.

By getting them connected to mental health care and medical supports. When you notice changes. And to not buying in to myths and misconceptions about aging that exists out there and influence all of us. I'd like to leave you with this idea that there is no expiration date on healing, transformation and love, and that every person at every age is worthy of mental health care and actually benefits from mental health care.

So when you see something lean in, get curious, provide hope and inspiration that treatment is available and help is possible. You have a really important role in dispelling these myths and getting older folks connected to care.

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