Dr Simon Adamson
The popular image of problem drinkers is, more often than not, a young person in town at 2am, or perhaps a middle aged person whose drinking may be in response to, and impacting on, family and work pressures. Younger and middle aged problem drinkers do get older of course and so can become older problem drinkers. It is also possible for problem drinking to emerge later in life for the first time. Drinking can become an issue for a variety of reasons later in life including becoming more social isolated through bereavement and retirement, chronic pain and insomnia, and increased family conflict.
Increased age brings with it a range of specific risk factors. Although most people continue to exhibit healthy cognitive functioning as they age our intellectual reserves, the spare capacity that comes in to play when under stress, become more limited and so heavy drinking can more easily push adequate functioning into the territory of poor functioning, with impaired memory, confusion, and poor decision making. As we become more physically frail intoxication presents greater risk of injury through falls, burns and cuts. Alcohol can act as a depressant and older adults are increasingly being identified as a high risk group for the development of clinical depression. Another critical factor to consider is the potential for alcohol to interact with medication, with older adults commonly prescribed a range of medications where this could be an issue.
As well as the risks associated with alcohol consumption there are potential benefits. In addition to the pleasure people gain from drinking alcohol, there is information to suggest that there are benefits to cardiovascular health with moderate alcohol consumption. These benefits are modest at best and don’t apply to everybody. Potential health benefits can easily be overemphasised and used to justify unhealthy drinking. The risk of over-doing it greatly exceeds the risk of under-doing it when it comes to alcohol consumption.
What is a safe level of alcohol consumption for older drinkers? National drinking guidelines are largely targeted at a younger population and may not be appropriate for older drinkers. The profile of drinking habits for older drinkers in New Zealand is typically frequent, often daily, drinking, but seldom in large quantities, more usually in the one to four drinks range. This contrasts with a youth pattern of less frequent but heavy drinking – i.e. a binge drinking pattern. This “steady state drinking” exhibited by older drinkers can appear harmless in contrast and flies beneath the radar. Given the health complications indicated above for older adults though it is cause for concern. For those in the 65+ age bracket it is advisable to drink no more than two “standard drinks” (1 standard drink = a can of beer or a 100ml glass of wine) and to have regular alcohol free days. If you are on medication discuss this with your doctor as even these amounts may be unhelpful.
Drinking problems can be difficult to identify in older adults as symptoms may be difficult to separate from possible dementia or depression. Deterioration in functioning can be difficult to pin down to the correct cause. This may lead family members, and even health professionals, to overlook the role of drinking. In addition, people who develop a drinking problem may become somewhat secretive about it and older adults are particularly prone to feeling shame under these circumstances and to also not want to bother relatives or burden the health system with their issues.
Talking with an older relative about their drinking may be an uncomfortable thing to do, but if you have any concerns, even if you are not sure, it is important to take the initiative and be honest about your concerns. If you are concerned about your own or someone else’s drinking call the Alcohol Drug Helpline on 0800 787797.
Dr Simon Adamson is a clinical psychologist specializing in alcohol, other drugs and behavioral addictions. You can learn more about him and his work at www.christchurchpsychology.co.nz.
