Dr. Regina Koepp 0:00
There is a set of 10 questions that I'm going to ask you to see if it might be helpful for you to discuss your own drinking with your own doctor. So one, when talking with others, do you ever underestimate how much you actually drink? Yes or no. Number two, after a few drinks, have you sometimes not eaten or been able to skip a meal because you didn't feel hungry? Yes or no? Does having a few drinks helped decrease your shakiness or tremors? Does alcohol sometimes make it hard for you to remember parts of the day or night? Do you usually take a drink to relax or calm your nerves? Do you drink to take your mind off your problems?

Dr. Regina Koepp 0:49
I'm Dr. Regina Koepp. I'm a board certified clinical psychologist and I specialize with older adults and families. I created the psychology of aging podcast to answer some of the most common questions I get about aging questions about mental health and wellness changes in the brain like with dementia, relationships, and sex, caregiving, and even end of life. Like I say in my therapy groups, no topic is off topic, we just have to have a healthy way of talking about it. So if you're an older adult, or caring for one, you're in the right place. Let's get started.

Dr. Regina Koepp 1:32
April is Alcohol Awareness Month. And so today we're going to be talking about alcohol use in older adults. Older Adults are people 65 and older. Many people 65 and older say that they do not feel old and don't consider themselves an older adult. What I will say though, is that there are some physiological changes in our bodies that we need to be mindful of as we consume alcohol in older adulthood. And so that's what I want to talk about today. Today we'll talk about what the rates of alcohol use are an older adults. I'll share three reasons why it is very important for us to talk about alcohol use in older adults, we'll explore what may trigger older adults to begin using alcohol or use more alcohol than normal. We'll explore the warning signs of alcohol use, like what you should be aware of and be looking out for. We'll talk about recommendations for how much alcohol is actually safe for older adults. And what to do if you yourself are an older adult who might want to cut back on drinking or get help for drinking. And then also what to do if you're a concerned family member and you want to help your older loved one to get some care and support for themselves.

Dr. Regina Koepp 2:55
At the outset of this episode, I'll share that all of the information that I'm going to be sharing are from the National Institute on Aging, the National Institute on Alcohol Abuse and Alcoholism, and Substance Abuse and Mental Health Services Administration. I'll also include links to all of these resources and references in my show notes and I really do hope that you check them out. There's so many great fact sheets and guides that can help you and your loved one. Okay, so what are the rates of alcohol use in older adults. So a 2017 study showed that alcohol is the most used drug among older adults, with about 65% of people 65 and older reporting high risk drinking. So they defined high risk drinking as exceeding daily guidelines at least weekly in the past year.

Dr. Regina Koepp 3:58
We'll talk about guidelines toward the end when we talk about how much alcohol is safe for older adults. So researchers also found that more than a 10th of older adults aged 65 and older currently binge drink and binge drinking is defined as drinking five or more drinks on the same occasion for men, and four or more drinks on the same occasion for women research published in 2020 showed that increases in alcohol in recent years have been greater for people 50 years old and older.

Dr. Regina Koepp 4:30
So why is talking about alcohol use and older adults so important? There's the common thought especially around red wine that consuming alcohol or drinking red wine can be beneficial for your health. There are some micronutrients and some red wines. But this isn't always true. So age related changes. Like as we age some physiological changes can make our bodies more sensitive to the effects of alcohol and One of the other challenges is that many older adults are likely to be taking medications for a chronic illness. And maybe that illness is managed with the medication. But then if you add an alcohol, or you add alcohol to the mix, it can interact with the medication and cause problems. Here's the other kicker is that alcohol can also interact with a medical condition and make that medical condition worse, or add more problems. So as our body ages, we have increased sensitivity to alcohol.

Dr. Regina Koepp 5:36
Aging can lower our tolerance. And we generally experience the effects of alcohol more quickly than we did when we were younger. And this puts us at higher risk for falls, getting into car accidents, where maybe you would have been fine to drive before in your life. And maybe that's not the case now. So falls are a big deal because you could fall and injure yourself and then have to have a surgery and then have all sorts of other issues as a result of that. And so, with increased sensitivity to alcohol, there can become more problems if we're not moderating our alcohol use.

Dr. Regina Koepp 6:17
So there are certain health problems that are more common in older adulthood. And heavy drinking can make these problems worse, like diabetes or high blood pressure, alcohol use, or heavy drinking has been shown to increase our risk of high blood pressure and heart disease could increase our risk for internal bleeding and ulcers increase our risk for stroke, liver problems, bone density issues like with osteoporosis, chronic pain, and impaired immune system, some cancers like stomach cancer of the larynx, pancreas, and so on. Also memory problems and dementia disorders, and mood and mental health concerns like depression, anxiety, and other mental health conditions. Moving on from increased health problems.

Dr. Regina Koepp 7:10
The third reason that it's important to talk about alcohol use in older adulthood is that like I mentioned earlier, we it's common to be taking a medication for a chronic health problem in our older adulthood. And so one of the big challenges with alcohol use is that it can interact negatively with medications. And that goes for prescription medications and over the counter medications, as well as herbal remedies. And I'll also say I know many older adults on more than one medication, and even when alcohol is not in the mix, having multiple medications is also a challenge for many older adults. And there can be some medication interactions leading to lots of problems. And so that's one piece already and then add to that alcohol use that just gets very complicated. So here are some examples of bad interactions with medications. So one is with aspirin if you take aspirin and drink your risk of stomach or intestinal bleeding is increased. If you're taking acetaminophen, alcohol use with large doses of acetaminophen, which is you know, like a common over the counter painkiller can cause liver damage. When you mix alcohol with cold and allergy medications, you could feel very sleepy. Those also you want to be very careful of even if you're not drinking, those can cause some confusion or disorientation or what looks like memory problems or dementia disorders. So just be mindful about cold and allergy medicines in general cough syrup also and laxatives. So they have high alcohol content. So if you drink at the same time your alcohol level could go up. And then interactions with sleeping pills and pain medications and anxiety or depression medication could also be really challenging. So and even in some cases fatal. So you really, really want to be careful if you know that you recreationally like to drink and you're you're prescribed medications, it's really important to talk with your physician about that and also with your pharmacist.

Dr. Regina Koepp 9:26
You know, our job as as health providers, medical providers, mental health providers, is to share information, make recommendations, and then you decide what you do with this information. But it is important that you know what some of the risks are, which is why we're talking about it today. So now that you know the three reasons why it's important to talk about alcohol use in older adults. So just as a refresher, those three reasons are increased sensitivity to alcohol, it can increase our health problems as we Age. And it could alcohol could negatively interact with medications that we're taking or over the counter pills or over the counter herbal remedies, and so on.

Dr. Regina Koepp 10:11
Now, let's look at what can actually trigger older adults to begin using alcohol or to use more alcohol than normal, like what makes us vulnerable. It's no surprise to you, I'm sure that as we age, we experienced many losses and transitions, we might experience the death of a spouse, our siblings, our parents, our children, friends, other family members, we could retire or experience the loss of a job. And with the loss of a job comes changes in our income and changes in our social status, our sense of contribution to the community, we also could lose our level of independence. And so maybe we have some mobility issues, and we don't get around as well. And so then we have to stop driving or stop using public transportation, maybe we have trouble walking, and we have to use assistive devices like a walker or cane, we could be losing our hearing or vision. We could have memory problems and be less confident and so maybe have changes in our own friendships, we could have health problems, I mean, the list just goes on. And this when when older adults or any human really experiences losses, like separation from people that we love, maybe you have to move, maybe you move into a senior living community, and that's away from the community you've lived in for the past 20 years. That's a big transition and a lot of loss, of course. So when we are coping with losses, what I would often see in my practice is sometimes the very last that we're coping with, like say the loss of our spouse, is the very person that we would go to for support when we needed them. So we might be grieving the loss of our spouse, and also our best friend, also our confidant, also the person who helped us to feel soothed and reassured and like I had a secure base, and a safety net. And maybe that's gone all of a sudden. And maybe at the same time as that's happening, you're moving when you're losing your own independence. I want to say older adults are incredibly resilient. Actually, they have the highest levels of resilience among any age group. And even with that said, there are times that we are vulnerable. And we to help cope, we might cope with losses by using substances. Also say during COVID caregivers, reported really high levels of stress, kind of one of the highest levels of stress among among adults, and also reported more alcohol use during COVID during the pandemic, the non caregivers. And so stress, of course, can also be make us vulnerable to coping using alcohol.

Dr. Regina Koepp 13:28
So what are the signs of alcohol use in older adults? When you notice changes in behavior or changes in your loved ones drinking or your own drinking, or maybe changes in a physical condition, that could be an indication of a drinking problem. So I'm going to review some symptoms and signs with you. One symptom or one sign does not mean there's a problem necessarily. It could be that could be a sign or symptom of a physical or mental health condition that's being managed. But when there are many signs or symptoms occurring all at once, that suggests maybe there is a problem. And then if there is, it's really important to get that checked out. So here are some signs and symptoms that an alcohol use, condition or alcohol misuse might be occurring. So making excuses or hiding or denying drinking, getting annoyed when somebody asks you about drinking blackouts or seizures, bladder and bowel incontinence or urinary retention, or difficulty urinating at all. Dry mouth dehydration, malnutrition, anorexia like no appetite, not eating or other changes in your eating habits. More memory problems, confusion or disorientation slurred speech, blurry vision, drinking in spite of medical warnings against it, arrests for drinking and driving or frequent car accidents, frequent falls unexplained bruising, increased tolerance to alcohol or withdrawal symptoms when the person's not drinking, drinking in the morning, noticing that you're not taking care of your house or your bills or your pets or your own hygiene, like you're not taking a bath or a shower as much or not shaving or brushing your teeth, maybe irritability or mood changes, strain in your relationships with friends and family. Maybe you're not as social as you used to be sleep problems, suicidal thoughts or, or planning, unusual kind of restlessness or agitation. And then like stomach problems like nausea, vomiting, heartburn. I just listed a lot of signs. If you are concerned, please, please consult with your physician, and also a mental health provider. There are lots of great treatments and options for you. And we'll be talking about those more in a minute.

Dr. Regina Koepp 16:36
So if you're 65 and older, and are currently drinking, there is a set of 10 questions that I'm going to ask you to see if it might be helpful for you to discuss your own drinking with your own doctor. So one, when talking with others, do you ever underestimate how much you actually drink? Yes or no? Number two, after a few drinks, have you sometimes not eaten or been able to skip a meal because you didn't feel hungry? Yes or no? Does having a few drinks helped decrease your shakiness or tremors? Does alcohol sometimes make it hard for you to remember parts of the day or night? Do you usually take a drink to relax or calm your nerves? Do you drink to take your mind off your problems? Have you ever increased your drinking after experiencing a loss in your life? Has a doctor or nurse ever said they were worried or concerned about your drinking? Number nine, have you ever made rules to manage your drinking? And number 10? When you feel lonely? Does having a drinkhelp? If you answered yes to two or more of those questions, it's recommended that you reach out to your doctor or speak with a mental health provider to talk more about how you are using alcohol in your own life, and the pros and cons and the risks and benefits to you and where you'd like to take it.

Dr. Regina Koepp 18:13
So what are the recommendations around how much alcohol is safe for older adults? So this is kind of a loaded question because Safe Drinking limits are really hard to set for older adults because the same amount of alcohol can affect people differently. So alcohol affects men and women differently. There are actually different amounts of alcohol that are recommended for each person if you are going to drink at all. The National Institute on Alcohol Abuse and Alcoholism recommends that adults 65 and older who are healthy and do not take medications. Drink no more than three alcoholic drinks a day or a maximum of seven drinks per week. Women are advised to drink less because our bodies react differently to alcohol than men's bodies do. So the National Institute on Alcohol Abuse and Alcoholism also makes a point to say that these drinking guidelines are not intended for people who plan to drive or perform activities requiring attention. not intended for people taking prescription medications or over the counter medications. not intended for people with certain medical conditions like we talked about earlier and not intended for people who are in recovery from alcohol misuse disorders. So if you are currently not drinking, it is not recommended that you start it's recommended that you stay not drinking. Also, those recommendations don't take into account our body weight and patterns of drinking or spacing of our drinks. And so that's important To be mindful of as well.

Dr. Regina Koepp 20:03
I also want to say a few weeks ago, I had a podcast on the best brain health recommendations. And actually the global Council on brain health, which is a collaboration of international experts on aging and brain health, recommend that if you do drink any alcohol, if you want to maximize your brain health, that, really, it should not be more than one drink per day for women and two drinks per day for men. So that's less than the National Institute on Alcohol and alcoholism recommends.

Dr. Regina Koepp 20:41
So if listening to this, you're thinking, Hmm, I might be one of those people with some health conditions, maybe I need to cut back my drinking or stop drinking altogether. If you do want to stop drinking, there's help, you could ask your doctor about medicines that might be helpful. You could talk to a trained mental health provider who knows about alcohol concerns and older adults, you could find a support group for people with alcohol concerns. You could attend individual family or group therapy depending on on what works for you, or attend a 12 step program like a bet like Alcoholics Anonymous, that offers support and programs for people who are wanting to stop drinking. If those sound of interest to you, there are links in the show notes to this website that will take you to those resources. So please don't hesitate to go there. Alcoholics Anonymous is also free. And you don't even have to say your name.

Dr. Regina Koepp 21:46
So many older adults actually do decide to quit drinking later in life. And if that sounds like you, you can do it too. There is this ageist idea which is false, that we cannot change when we're old, like old dogs can't learn new tricks. And that is wrong. There are many, many things that you can do to cut back or stop drinking at any age. And I can tell you from my own experience, and Research also shows that older adults are indeed capable of change, and you can do it too. So if you'd like to cut back, you could simply pay attention to how much you're drinking each day and follow the recommended guidelines. So no more than three drinks per day, you could decide on how many days a week you want to drink, and then plan some days that are free altogether of alcohol. You could pace yourself when you drink, so don't have more than one alcoholic drink in an hour. And then in place of alcohol, you could drink water or juice or soda. All that sugar might not be good for a diabetes condition. But might be better than alcohol. Make sure to eat when you're drinking. So alcohol will enter your system more slowly. If you eat some food at the same time. You could try even removing alcohol from your home, I have to do that with some chocolates, sometimes. You could ask for support from your family and advice from your health care provider and get the help that you need to quit.

Dr. Regina Koepp 23:21
I know that there are a lot of people who listen to this podcast who are helping an older loved one and and so I want to also share some tips on how to help an older adult with a drinking problem. So what's so difficult is when we see, I was just talking to a friend of mine a couple of weeks ago, and her loved one was not necessarily drinking but was engaging in some behaviors that were very risky. And I and I said out loud, just kind of reflecting on the problem. Oh, it's so hard to see your dad kind of going full speed into a brick wall. And there's nothing you can do to stop it. And, and while I said that I thought well, you know what, there are some things that we can do to help. And so here they are. One thing that we can do or you can do is to talk about your concerns with your loved one when they are sober. So try to say what you think or feel like I'm concerned about your drinking. I'm noticing this and I'm really concerned about you. Your Loved One might be open to hearing facts about older adults and drinking but not necessarily open to hearing about your concerns. They might brush you off. And so if they are open to hearing about facts, you could have them listen to this podcast, you could pull up some of the articles that I'll have linked in this podcast which are all from the National Institute on Aging the National Institute on Drug Abuse the National Institute on health hauling alcoholism, lots of evidence based resources and facts. You could say I'm concerned about you and your drinking. I know that our bodies change and our the way that we process alcohol in our bodies changes as we get older, would you be open to listening or hearing about some of those facts that I've just recently learned, and then share the facts with them. If you are having a conversation, it's really important to stay away from labels like you're an alcoholic, you've always been an alcoholic. So try not to label your loved one, try not to shame your loved one. I, my heart goes out to you, this is a really hard conversation, especially if this problem has been going on for a long time, you'll have a lot of feelings about it.

Dr. Regina Koepp 25:49
And so we're going to get to what you can do for yourself as well. As you're talking, you could also offer to help your older loved one to see their doctor. I have another episode and article on how to help your older loved one who's refusing to go to the doctor that could be helpful here as well. So I'll link to that in the show notes. Another thing that you can do is offer help like, like suggest things to do that don't include drinking, like, Hey, Dad, can we go, you know, to the Botanical Gardens? Or would you be up to going on a drive with me, you could encourage counseling or mental health support, or attend a group meeting. If your loved one is interested in church or other community activities, you could try that you could offer to drive your loved one to and from the meetings. And you if your loved one is engaging in treatment, which would be awesome, you could give your support during their treatment.

Dr. Regina Koepp 26:59
The final thing that you can do to help an older loved one with a drinking problem is to really take the time to care for yourself, too. Like I said a minute ago, if this is a long standing problem, it's going to bring all sorts of history and your relationship up for you. And that is very, very difficult and very, very painful and sometimes too much to carry all by yourself. It can really help to talk with mental health provider to help you process that or somebody that you trust. You could also involve other family members or friends so that you're not alone. Like say, say you have siblings and you need their support and their camaraderie. You could talk honestly about how you're feeling and try to say what support or help you actually do need. You yourself could go to therapy or something like Al anon. So al anon is a support group for friends and family people with a drinking condition or drinking substance use disorder. And I'll link to where you can find al anon near you as well.

Dr. Regina Koepp 28:08
So there you have it. Lots and lots of information about alcohol use in older adulthood. I hope what you do take away from this is that care and change is available impossible. Care is available and change is possible. For older adults. I think professionals need to believe that family members who are helping older adults need to believe that and older adults need to believe that care is available and change is possible. And you're not alone with this. There are a lot of resources out there to help you. And I'll link to them in the show notes.

Dr. Regina Koepp 28:50
Oh, let me tell you, Oh, you guys, I'm so excited. So I have been working really, really hard over the last year to come up with how do I want to help older adults around and their families around Mental Health and Aging. I have decided to create the Center for Mental Health and Aging, which will be your go to place online for the mental health care of older adults. It's in development. We're building it right now. And what I'm hoping what I'm planning for it to be is the go to place for mental health care for older adults. So you'll get lots of information about what typical aging is what, what's concerning, and actually access to mental health providers who specialize in older adults. So I'm in the process right now of building it. If you are a professional like you're licensed mental health provider like a therapist, and you specialize with older adults or neuro psychologist and you specialize with older adults or a psychiatrist and Do you specialize with older adults, I will be creating a directory of providers, licensed mental health professionals who will be able to care for older adults in their own practices. So stay tuned. I'm really excited. It's in the development phase now, and I'm hoping, hoping that it will be launched within the next month. So, if you are a licensed mental health professional neuropsychologist, therapist, or psychiatrist, then send me an email and I would love to talk with you about how to get your name in that directory so that older adults in their families can get the help that they need by getting access to you. So stay tuned. I'm so so excited. Oh, it's just the greatest gift to be able to offer support and care on a national scale to older adults and their families and to begin to De-stigmatize mental health for older adults. I think it is my life's work. So I hope you stay tuned and join me in the movement to promote mental health for older adults.

Dr. Regina Koepp 31:10
That's all for today. Now it's your turn. All you have to do is subscribe, leave a review and share this episode with others so that they can be part of the conversation too. One last thing, a special thanks to Jasmine Joyner our psychology of aging podcast in turn for all you do. Lots of love to you and your family. Bye for now.