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1 Older Women and Alcohol on Thu Jul 24, 2008 9:01 pm


More than half of women over 65 years drink alcohol, at least occasionally, and many are affected by the drinking of someone they love. Most older women drink moderately and for pleasure. But others can begin to drink more than is healthy, and to rely on alcohol to cope with major changes, such as physical or emotional pain, coping with caring for a spouse who is also ageing or ill, death of a spouse, and poverty.

The Connections Between Ageing and Alcohol

These days, we often hear good things about alcohol and ageing. The research is clear: moderate drinking is okay for older women. This means no more than one standard drink a day (such as one 12 ounce beer or a 5 ounce glass of wine), and is only true if you are not on pain medication, tranquillizers, or other drugs.

About 1 in 12 older women has a serious problem with alcohol. Many have had this problem for a long time. But for many others, the problem is new. Drinking too much can affect women of all age levels, but there are specific things that older women should watch out for.

Nutrition: Drinking can often make you feel much less like eating. Alcohol also blocks your body's ability to absorb and use vitamins. This can lead to poor nutrition, which puts your body under stress.

Accidents: You can be more susceptible to falls and fractures. This isn't because you're "falling down drunk" but because alcohol can weaken muscles and damage nerves.

As is true for anyone, drinking can also affect your driving. Studies have shown that drinking-related accidents that cause injury and death are a significant problem for seniors. And injuries caused by car accidents tend to be more serious for seniors than for younger people.

Drinking alcohol while on medication: Over 150 common drugs and medications can adversely interact with alcohol: antibiotics, aspirin, pain killers, and sedatives such as Valium. The list also includes common medications for blood pressure, heart problems, diabetes, and stomach conditions. Many over-the-counter drugs and herbal remedies can also cause problems if you drink while taking them.

Studies show that women over the age of 65 are the most likely age group to be prescribed sedatives. If your doctor gives you sedatives, talk with him/her or your pharmacist about whether there are any risks if you drink alcohol while taking your prescription.

Memory problems: Drinking too much can make it difficult for you to remember things that happened recently. This memory loss is not due to ageing.

Body chemistry changes: As you grown older your body goes through major changes in metabolism. You produce less of the chemical that breaks down alcohol, and your liver and kidneys work more slowly. As a result, alcohol remains in your body much longer, causing damage.

Stomach problems: You can get stomach problems from drinking, including indigestion, gastritis, and ulcers. Alcohol also significantly increases your chances of developing mouth or stomach cancer.

Depression: Some older women drink to cope with loneliness, depression, and anxiety. But depression can arise from one's alcohol use, instead of alleviating it.

Abuse: Alcohol use can also be connected to abuse of seniors. Sometimes when "friends" or family drink they can become violent or emotionally abusive. They may even become financially abusive and take money away from you. When older women are under the influence of alcohol, clear decision making is more difficult, making them more vulnerable to remaining in abusive situations. And older women may also overuse alcohol to cope with the shame or guilt they feel about abuse done to them. Charmaine Spencer..Sue McGowan..Nancy Poole..Womens Addiction Foundation

2 Re: Older Women and Alcohol on Thu Jul 24, 2008 9:18 pm


Elderly Alcohol and Substance Abuse
Alcohol and substance abuse among the elderly is a hidden national epidemic. It is believed that about 10% of this countryís population abuses alcohol, but surveys revealed that as many as 17% of the over-65 adults have an alcohol-abuse problem. In his work at the University of Kentucky, Dr. Hays found that 2.5 million older adults and 21% of older hospital patients had alcohol-related problems. (Hays, L. et al. Presented at a symposium for the American Academy of Addiction Psychiatry 2002 Symposium: Substance Use Disorders in the Elderly: Prevalence, Special Considerations and Treatment.)

Elderly alcohol abusers can be divided into two general types: the "hardy survivors," those who have been abusing alcohol for many years and have reached 65, and the "late onset" group, those who begin abusing alcohol later in life. The latter groupís alcohol abuse is often triggered by changes in life such as: retirement, death or separation from a family member, a friend or a pet, health concerns, reduced income, impairment of sleep and/or familial conflict. Because alcohol has a higher absorption rate in the elderly, much like it does in women, the same amount of alcohol produces higher blood alcohol levels, causing a greater degree of intoxication than the same amount of alcohol would cause in younger male drinkers.

Alcohol abuse in this generation is complicated by the use of prescription and over-the-counter (OTC) medications. The elderly spend over $500 million yearly on medications. Combining medications and alcohol frequently result in significant adverse reactions. Due to a reduction in blood flow to the liver and kidneys in the elderly, there can be a 50% decrease in the rate of metabolism of some medications, especially benzodiazepines. Additionally, chlordiazepoxide (Librium?) and diazepam (Valium?) have such long half lives (often several days) in the elderly that prolonged sedation from these drugs, combined with the sedative effects of alcohol, can increase the risk of falls and fractures. The benzodiazepine user may become confused and take extra doses or other medications, causing overdose or death.

Serious consequences can result solely from OTC medication use, as well as combining them with alcohol. Laxatives, for example, can cause chronic diarrhea, which can lead to sodium and potassium imbalance and cause heart rhythm irregularities. Antihistamines, another popular OTC medication, can cause confusion; cold medications can elevate the blood pressure and lead to strokes. Caffeine is frequently added to OTC medications and can cause anxiety and insomnia. Often, mixing alcohol and the OTC medications increases the occurrence of side effects and can intensify negative consequences.

Nicotine dependence is also a significant problem in the elderly, due both to their addiction and boredom. Use early in life sets the stage for morbidity and mortality from this addiction. Over 400,000 people in the U.S. die each year from smoking-related diseases. Elderly smokers not only continue to impair their respiratory systems, but are also more apt to die from respiratory diseases. Nicotine replacement products work successfully in this group, especially when combined with behavioral, supportive and other therapies.

The problem of elderly substance abuse may be difficult to detect when the elderly live alone. Friends and family may be reluctant to even consider that there may be a problem and medical evaluations often do not reveal substance abuse. Consideration should be given to the presence of a drug and/or alcohol problem if there is memory loss, depression, repetitive falls and injuries, legal problems, chronic diarrhea, labile moods, malnutrition and recent isolation. Elderly women are more likely to have a diagnosed or undiagnosed depression. According to Dr. Hays, prescription drugs, particularly benzodiazepines, may be abused by these women.

The Center for Substance Abuse Treatment published a list of signals that may indicate an alcohol or medication - related problem in the elderly:

Memory trouble after having a drink or taking a medication
Loss of coordination ( walking unsteadily, frequent falls)
Changes in sleeping habits
Unexplained bruises
Being unsure of yourself
Irritability, sadness, depression
Unexplained chronic pain
Changes in eating habits
Wanting to stay alone much of the time
Failing to bathe or keep clean
Having trouble concentrating
Difficulty staying in touch with family or friends
Lack of interest in usual activities
Education for and from healthcare providers, family and pharmacies is paramount. The healthcare provider can use simple screening tests such as the AUDIT-C, CAGE and/or the Short Michigan Alcoholism Screening Test - Geriatric Version (S-MAST-G).
A familyís attention to the elderly family memberís daily life can be extremely helpful in identifying medical and social problems. It is important to develop a medication inventory for an elderly person. This inventory is a list of all of his or her prescribed and OTC medications. The final inventory usually uncovers a surprising number of OTC medications (some studies have shown as many as nine different medications used per month). This list of medications can be brought to a local pharmacist where a drug - drug interaction list can be generated.
Another worthwhile consideration would be to try to increase the activity level and social interactions of the elderly family member. Senior groups and volunteer work are examples of ways to increase companionship and self esteem.
Clinical treatment may need to be considered, as well as pharmacological interventions as a possible adjunct to clinical treatment. Naltrexone (ReVia ?) appears to work as well in the elderly as in other groups of alcohol -dependent patients to decrease the craving and feeling of elation related to alcohol use. Antabuse should probably be avoided because the elderly cardiovascular system may not be able to handle possible cardiac events that could occur with an alcohol - antabuse reaction.
Twelve-Step, self-help and support group participation should be considered.

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