Does alcohol affect older persons differently?

The aging process alters a person's response to drugs of all kinds. Metabolism is slower because of the reduced size of the liver. Declining kidney function delays the elimination of drugs. Vulnerabilities to drug sensitivities and drug interactions are due to the decline in the aging body's water content, increased fat content, decreased lean body mass, and a diminished hepatic blood flow. There is a greater sensitivity to lower drug levels and a greater vulnerability for drug-drug interactions and toxicity in older adults. Consequently, a standard dose of alcohol in an older person will result in a higher blood alcohol level because the alcohol clears the body more slowly in a 60 year old than it does in a 20 year old. The aging brain is also more susceptible to the effects of alcohol. Concurrent use of drugs and alcohol can significantly change a drug's actions that may lead to toxicity. The greater variety of drugs, both prescription and over-the-counter, that are used with alcohol, the greater potential there is for adverse reactions. Table 18 reflects some age related changes in response to drugs and alcohol.

Statistically, alcohol and drug abuse among older persons has reached epidemic proportions and remains underreported, undiagnosed, or ignored. The prevalence of older people who have a problem with alcohol ranges from between 2% and 10%.

Consequently, a standard dose of alcohol in an older person will result in a higher blood alcohol level because the alcohol clears the body more slowly in a 60 year old than it does in a 20 year old.

Table 18 Age-Related Changes in Response to Drugs and Alcohol

Studies of older hospitalized patients have demonstrated much higher rates of alcoholism, ranging from 8% to 70%. Nearly half of the older persons who are hospitalized for a medical problem are abusing alcohol, which has compromised their health. Older men outnumber older women alcoholics by 4 to 1, although women are more likely to start drinking heavily in mid to late life. Few are dependent on illicit drugs, although they are more likely to misuse or even abuse over-the-counter and prescription medications. The epidemiological literature examining the risk factors as predictors for late-onset alcohol problems is extremely limited. Several studies reported that late- onset alcoholics are not likely to have family histories of alcohol abuse, and only a few have legal or social problems as compared with early-onset alcoholics. Evidence shows that late-onset alcoholism is more likely to be the result of maladaptive responses to stressors that are common during the aging process, including social, psychological, and physical changes.

Factors Associated With Drinking and Older Persons

• Social factors: social isolation, poor housing or residential changes, reduced finances, loneliness, loss of social support systems

• Psychological factors: depression, grief and loss of a spouse and close friends, loss of self-esteem associated with unemployment, anxiety, fears either warranted or unwarranted, fear of crime

• Physical factors: loss of youth, loss of mobility and strength, decreased acuity of the senses, loss of health because of either chronic or acute illnesses, such as heart disease, hypertension, diabetes, lung disease, or arthritis

Suicide among older persons is a big problem. Twenty- five percent of those who commit suicide are older than 65 years. The rate of suicide for older adults is five times the general population. Alcohol use is involved in one third of older-persons' suicides. No age group is immune to the problems associated with the misuse of drugs, alcohol, over-the-counter drugs, and prescription drugs, but older people have problems that are unique to their age group.

No age group is immune to the problems associated with the misuse of drugs, alcoholover-the-counter drugs, and prescription drugs, but older people have problems that are unique to their age group.

Higher rates of substance abuse, including alcohol, tobacco, and other drugs, actually exist among rural teens.