This leaflet is provided by the Royal College of Psychiatrists, the professional body responsible for education, training, setting and raising standards in psychiatry. They also provide readable, user-friendly and evidence-based information on various mental health problems.
This leaflet is for:
- Older people who are worried about their drinking.
- Carers, friends or health professionals who are worried about an older person’s drinking.
- Anyone who wants to know more about the problems of drinking in older people.
- Finding out how to seek help.
What's different about alcohol for older people?
As we get older, our bodies change. On the outside we notice lines, wrinkles, extra weight. Our skin is perhaps not quite as strong or flexible as it used to be. On the inside we:
- Lose muscle.
- Gain fat.
- Break down alcohol more slowly.
This means that we become more sensitive to the effects of alcohol. We also react more slowly and tend to lose our sense of balance. So, even if we drink the same amount of alcohol, as we get older it is likely to affect us more than younger people.
How much is it safe to drink?
The more you drink, the more likely it is that alcohol will harm your health; but there are 'sensible' levels of drinking which, for most people, are unlikely to be harmful. These are roughly:
- 14 units of alcohol a week for women.
- 21 units for men.
However, the changes mentioned above mean that safe drinking levels for older people are probably less than this.
Many drinks now show the number of units they contain on the bottle. But to give you some idea:
- A pint of light beer (4%) or a double whisky both contain two units.
- A 75 cl bottle of wine contains 8-10 units and so a glass of wine might contain anything from 1¼ to 3¼ units depending on its size.
Weekly limits can be misleading. If just a quarter of the recommended weekly amount is drunk over a matter of hours, this is more likely to be harmful.
Drink Aware (see below) has further information on 'what is an alcohol unit?'.
Are there any risks to 'sensible' drinking?
Just because we drink within the limits does not mean that it is safe. Very little research has been done on older people so we may be mistaken in thinking that these limits apply to everyone. There are also some particular problems:
- Health problems can make us more susceptible to alcohol.
- Balance gets worse with age - even a small amount of alcohol can make you more unsteady and more likely to fall.
- Add to the effect of some medications - eg, painkillers or sleeping tablets.
- Reduce the effect of others - eg, medication to thin the blood (warfarin); this can increase the risk of bleeding or developing a clot or blockage in your bloodstream.
Check with your doctor about whether it is safe for you to drink with your particular health problems or medication.
How many people drink too much?
Older people tend to drink less alcohol than younger people, but even so 1 in 5 older men and 1 in 10 older women are drinking enough to harm themselves. These figures have increased by 40 per cent in men and 100 per cent in women over the past 20 years.
What are the risks of drinking too much?
Alcohol can damage nearly every part of the body:
- The stomach lining → ulcers or bleeding.
- The liver → cirrhosis and liver failure.
- Heart muscle → heart failure produces a build-up of fluid in the lungs which makes you breathless.
- Cancer → of the mouth, stomach and liver.
- Malnutrition → alcohol has lots of calories for energy, but none of the protein, fats or vitamins you need to keep your body in good repair.
- Sense of balance → falls and accidents (even with 'sensible' drinking).
- Blackouts or fits.
- Poor sleep → daytime tiredness.
Not everyone who drinks too much will develop health problems but, the more you drink, the more likely you are to get such problems.
Isn't drinking good for the heart?
If you drink about 1 unit a day, you are slightly less likely to have a heart attack. This finding came from studies in men in their 40s and 50s - so it may not apply to everyone.
It will make more of a difference if you control your weight, take exercise and make sure that you get proper treatment for any high blood pressure, high cholesterol or diabetes.
How can alcohol affect mental health?
Too much alcohol can cause:
- Anxiety: this may be because you start to feel anxious as the alcohol wears off - like a mild withdrawal symptom. So you have a drink to feel better - but as the effect of that wears off, you start feeling anxious again.
- Depression: you feel less hungry, have difficulty sleeping and get tired more easily. You start to feel that you have lost interest in things you used to enjoy, are slower to take things in when reading or watching television and feel less positive about the future - or even feel that life is not worth living.
- Hearing voices: this is less common but can happen if you have been drinking heavily for a long time. It starts with vague noises, like leaves rustling, and gradually becomes distinct voices. These can be unpleasant and are usually distracting.
- Confusion: if you have been drinking but not eating, the lack of thiamine, an important vitamin, can make you confused and unsteady on your feet. If this is not treated urgently, you can get permanent damage to your short-term memory - this is called Korsakoff's syndrome.
- Dementia: you can lose your ability to remember new information, which may be put down to 'old age', instead of the effects from alcohol.
How might an older person develop an alcohol problem?
About a third of older people with drinking problems (mainly women) develop them for the first time in later life. Bereavement, physical ill health, difficulty getting around and social isolation can lead to boredom and depression. Physical illness may be painful and it can be tempting to use alcohol to make these difficulties more bearable. It may then become part of our daily routine and difficult to give up. There may be less pressure to give up drinking than for a younger person, fewer family responsibilities, and no pressure to go to work each day.
It is possible that health professionals don't spot heavy drinking in older people as often as they should, because:
- Older people tend not to talk about their drinking, perhaps because of embarrassment.
- They mistake the effects of alcohol for a physical or mental health problem.
- They forget that older people may have drink problems so they don't look so hard for it.
- They don't have time to ask older people about their drinking.
What help is available?
It is often easier to treat drink problems in older people than it is in younger adults.
- Detoxification, or 'detox'. This involves giving medication to reduce withdrawal symptoms and then tailing off and stopping it after a few days or weeks. In older people this is usually best done in hospital.
- Support groups. Many people find that self-help groups like AA (Alcoholics Anonymous - see below) are the most helpful way to overcome a serious drink problem. But they don't suit everyone. They tend to work on stopping drinking completely and many older people may just want to cut down. If you have mobility problems, it can be hard to get to meetings.
- Psychological, or 'talking treatments'. Treatment can be 'one to one' or with a group of other people, where you can share your experiences with others. Therapists are trained to talk about your problems without judging you. They can help you to stop drinking completely, or to control your drinking better. This can take some time and there may be setbacks. This is normal and one setback should not be seen as a failure.
- You will also need to find ways to occupy yourself with activities, so you can get out of the daily routine that revolves around alcohol. Friends and family may be able to help with this.
- Acamprosate and naltrexone are medications for alcohol if you have stopped drinking. They are mainly prescribed for younger people as it is not known how safe or effective they are for older people.
- Helping with the problem that made you start drinking in the first place. This could be anxiety, depression, physical problems or just not seeing other people very much.
What do I do now?
If you think that you have an alcohol problem, talk to your doctor. If necessary they can arrange for you to have tests, see a counsellor, or be referred to an NHS alcohol team in your local area.
There are also a number of organisations offering free advice for alcohol problems.
Further reading and references
- The Royal College of Psychiatrists (2011) Our Invisible Addicts: College Report CR 165. London: The Royal College of Psychiatrists.
- Rao, T. (2011) Older people and dual diagnosis - out of sight, but not out of mind. Advances in Dual Diagnosis, 4(1), 4:6.
Content used with permission from the Royal College of Psychiatrists website: Alcohol and Older People (November 2012, due for review November 2014). Copyright for this leaflet is with the Royal College of Psychiatrists.
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