Winter Maladies: Natural Approaches
June Russell's Health Facts
Alcohol - Seniors
[Drug Awareness/Health Agency Facts] [Double Whammies]
[A Single Drink] [Suicide]
Polls show that seniors fear being incapacitated and being in pain more than they fear death, and they value independence and do not want to be a burden to anyone. The risks that come with alcohol use is one many older individuals choose not to take, for while one-third of the adult population chooses to abstain from alcohol use, seniors are more cautious and approximately half do not drink at all.
The U.S. Department of Health and Human Services tells us there is no ‘safe’ level of alcohol use, and they remind us that the result of a single alcoholic drink is “relaxed inhibitions, impaired judgment, slowed reaction, and impaired motor coordination.” One drink not only puts part of the brain cells temporarily out of order, but the brain is anesthetized long after the blood alcohol concentration (BAC) returns to normal. This is true whether an alcoholic drink is taken at a social function, with a meal, or when alone. Seniors are at special risk because one drink (sometimes even less) can result in a fall which may require hospitalization, or result in errors such as taking the wrong amount of medication. When driving a car, it takes only a small amount of alcohol to interfere with coordination and judgment, which can result in errors, such as stepping on the accelerator instead of the brakes. MADD tells us that it only takes one drink to double the risk of an accident. There is added risk if the alcohol is mixed with a medication.
Those individuals who are between the ages of 55 and 64 fill an average of 12 prescriptions a year; those over 65 even a greater number. This doesn't count the use of over-the-counter drugs. Older individuals are more prone to adverse reactions because they use more medications and their body is less able to break down the drugs and eliminate them. (As we age, our liver gets smaller.) Mixing alcohol with prescription or over-the-counter drugs is not only dangerous but it can be lethal!
The drinker is deceived into thinking that an ‘alcoholic drink’ is relaxing, when it is actually ‘drugging’ the drinker, which makes it an added stress. True relaxation is obtained by positive health habits such as exercise and meditation. As we grow older, the body’s response to all stress, including alcohol use, is greater and lasts longer.
Relationship between Alcohol and Aging
There is a correlation between the loss of white matter in the brain and alcohol intake. There is a link between alcohol and aging. Alcohol may promote the aging effects on the brain, or aging and alcohol may act synergistically.
The use of alcohol increases the risk of causing a car crash, and alcohol use appears to have an even greater impairment for older persons, as well as their being more vulnerable to injury.
In regard to the effects of alcohol on sleep and driving: older persons are known to have a widespread complaint of insomnia and sleep disturbances, and this, with the changes in driving performance of those who are aging drivers, has major public health implications.
Older persons are more likely to be taking multiple medications, and if they mix alcohol with medications, this is a potential for significant danger. There is a link between alcohol and aging. There is a correlation between the loss of white matter in the brain and alcohol intake, and this white matter correlates with cognitive functioning.
Natural immunity tends to decline with age and alcohol ingestion may also play a role because studies show that natural killer cell activity is suppressed for as much as four hours after alcohol consumption. There are reports that light drinking reduced cardiovascular risk more among the elderly than the youn: even saying that moderate drinkers have a lower mortality than abstainers. However, these studies are called into question because of other variables such as smoking, hypertension, obesity, and physical activity. Some literature has also suggested that light alcohol consumption has a protective effect against ischemic stroke but studies are divided at this point.
Drinking alcohol increases the effects of stress on depression in the elderly. When sleep deprived, alcohol’s effects are more sedating (and the use of alcohol will also increase the likelihood of snoring). Alcohol use can cause sleep disruption the second part of the night which can result in daytime fatigue and sleepiness, and may result in unsteadiness during the nighttime trips to the bathroom, with an increased risk of falls and associated injuries. Alcohol consumption may also affect the likelihood of having periodic leg movements during the night that would interfere with sleep. Impairment in performance begins at below 0.02 percent BAC (0.02 percent can be the result of 1 to 1-1/2 drinks).
Alcohol can modify one’s judgment, which makes seniors more vulnerable to injury, and men are more likely to believe that alcohol use will not affect their performance. Some of alcohol’s effects mimic changes that normally occur with aging, and its use may produce additive deleterious effects.
In addition to adverse effects on the liver, heart, gastrointestinal tract, and immune system, alcohol consumption increases the risk for some cancers, disturbs sleep, and interferes with cognitive and motor impairment. It increases the risk of falls, other types of accidents, and motor vehicle crashes. In addition it increases the chances of violence, depression, personal neglect, an inability to carry out responsibilities, and a disruption of personal relationships.
Older persons appear to be more sensitive to alcohol, and even though some studies have found a positive effect of moderate alcohol intake among healthy elderly persons, it should be noted that many of the problems mentioned may occur for some older individuals at very low levels of drinking.
{“Alcohol Problems and Aging,” Research Monograph - 33, NIAAA, 1998}
In the U.S. the number of people 65 and older is 35 million (13% of population) and the number of people 85 or older is four million, according to “Older Americans 2000,” U.S. Census Bureau.
Alcohol - Medications and Seniors
Mixing alcohol with prescription drugs sends more older people to the hospital than anything else, says Larry Goodwin, manager of the Addiction Treatment Center at Montgomery General Hospital.
Alcohol can stimulate the liver to turn other drugs into a very toxic metabolic product which, in turn poisons the liver.
{Public Citizen’s Health Research Group}
There are many problems that can arise from alcohol use and prescription drugs, from drowsiness all the way to death, and alcohol can change the effectiveness of the drug treatment.
{Modern Maturity, AARP publication, Feb./March 1992}
According to a 1991 study by Penn State Biobehavior Program, it was found that 70% of the elderly were taking one or more alcohol-interactive drugs, and about 20% of these said they used alcohol.
{Washington Post Health, April 1994}
Nearly one in four older Americans well enough to live on their own, an estimated 6.6 million, are taking potentially dangerous or inappropriate medications, according to JAMA (July 1994). Eighty-nine percent of the seniors surveyed received some type of prescription medication. According to the Public Citizen’s Health Group, two-thirds of the prescriptions filled by older adults are either unnecessary, more dangerous than other available drugs, or given in unnecessarily high doses.
{“Seniors Being Overmedicated,” People’s Medical Society newsletter, Dec. 1994} Editor's comment: Reason enough to not add another drug (alcohol) to the ‘mix.’
Avoid alcohol when taking over-the-counter pain relievers such as aspirin, ibuprofen (Advil, Motrin), and Naproxen (Aleve). Alcohol can intensify any stomach irritation or gastrointestinal bleeding that may occur with prolonged use of these and other NSAIDs drugs. A professor of medicine at Johns Hopkins, Dr. Michael Klag, performed a study on acetaminophen and advised that those who take acetaminophen should avoid alcohol.
{The Johns Hopkins Medical Letter, ‘Health After 50,’ Jan. 1996}
Any use of alcohol may be viewed as a health risk in older individuals, whose use of prescription medication may result in adverse interactions. Approximately 90% of elderly persons are using some kind of medication, either prescription or over-the-counter. Because of the decrease in the percentage of body water content with age, small amounts of alcohol can result in high blood alcohol levels. Alcohol use also makes sleep difficulties worse, elevates blood pressure and has a detrimental effect on bone mineral metabolism.
{Alcohol Problems and Aging: 1998, U.S. Department of Health and Human Services (NIAAA).
According to the National Institute on Aging, alcohol slows down brain activity. Drinking alcohol increases the risk of falls and accidents because alcohol affects alertness, judgment, coordination and reaction time. It can dull pain that may be acting as a warning sign, such as a heart attack. Alcohol can cause forgetfulness and confusion, which can mimic Alzheimer’s disease symptoms.
For older adults: alcohol slows brain activity. Alcohol impairs mental alertness, memory, judgment, physical coordination, and reaction time. Alcohol can make medical problems worse. Some medications increase the intoxicating effects of alcohol, and can interfere with the medical benefits of certain drugs.
{Healthwise for Life, “Medical Self-Care for People Age 50 and Better,”1998}
Older persons are more likely to be taking multiple medications, and if they mix alcohol with medications, this is a potential for significant danger.
{“Alcohol Problems and Aging,” Research Monograph - 33, NIAAA, 1998}
As many as 90% of older adults use medications, and as many as one hundred of them may interact adversely with alcohol.
{“Alcohol Use Disorders in Older Adults,” The American Geriatrics Association, americangeriatrics.org - Dec. 1999}
Alcohol mimics symptoms of aging, also, the body’s ability to remove alcohol from its systems is reduced with age. The metabolic rate often slows with age which also results in alcohol staying in the body longer. Alcohol can irritate the digestive tract and damage the lining of the stomach.
{“Alcohol and Seniors,” Group Health Cooperative, Dec. 1999}
One of James Duke’s seven secrets for growing youthful is to limit or eliminate alcohol.
{from the book, “The Green Pharmacy Anti-Aging Prescriptions,” by James Duke, PhD, famous herbalist}
A National Institute on Aging study found that overall, menopausal women had increased odds of six chronic conditions: high blood pressure, arthritis, diabetes, heart trouble, osteoporosis and cancer. Those who have had surgically induced menopause reported a higher frequency of all six chronic conditions.
{HealthCentral.com - Oct. 2000} Editor's comment: Alcohol use is a negative for all six (including menopause).
The normal process of aging causes the blood flow to the brain to decline, and alcohol use accelerates this. In the book, “Stopping the Clock,” the authors recommend avoiding alcohol to lessen the effects of aging. The older a person is, the more alcohol will ‘age’ him/her. Alcohol accelerates the deterioration of cell membranes in the brain (which is a normal part of aging) and hampers learning, memory and other functions.
Alcohol is known as a sleep deterrent, and the elderly should avoid alcohol in the evening.
{“The Ability to Sleep,” About.com/health/sleep disorders - May 2001}
“Alcohol itself is a toxin; it’s poisonous: it poisons the body,” said E. Don Nelson, a professor at the University of Cincinnati and teacher for the National Institute on Drug Abuse. Alcohol tolerance drops as people age, and less alcohol is metabolized in the stomach, placing an additional burden on the liver. Alcohol mixes unfavorably with many drugs, including prescription and over-the-counter medications.
{“Alcohol - Silent Killer of the Elderly,” Associated Press, tallahasseedemocrat.com, Jan. 2001}
The average older adult in the U.S. takes five prescribed drugs a day, half of which contain a sedative. Add alcohol to the bodily effects of aging and prescription medicine, and you have the potential for several very serious health problems, warns Carol Colleran, director of the Hanley-Hazelden Center of Recovery for Older Adults in West Palm Beach, FL. Also, few clinical trials of new medications involve older subjects, so clinicians have no way of predicting or recognizing adverse reactions, or unexpected effects in seniors.
{"It Couldn't Happen to Me," Prevention magazine, March 2002}
Areas of Concern that May Affect Seniors
It is recommended that you avoid alcohol several days before going into surgery {JAMA 1995}. The nitroglycerine packet warning says not to use this drug with alcohol. Editor's comment: Therefore a person who has alcohol in their body will run an additional risk if they need emergency surgery, or if they must use nitroglycerine.
Although alcohol raises HDL, it is still suspect because it raises triglycerides and blood pressure and may cause a host of other problems.
{The Cooper Clinic Cardiac Rehabilitation Program}
Although there is no age for exemption for safe sex practices, many seniors are still having sex but are not getting the message. People 50 and over have steadily accounted for 10 percent of the new AIDS cases each year for the past 20 years, but a few years ago the rate among seniors began to climb, according to the Center for Disease Control and Prevention (CDC). About 10 percent of Americans over 50 have at least one risk factor, having sex with multiple partners and not using condoms consistently. So few seniors have been tested, it is hard to know how many are infected, and many unknowingly pass it on to others. Editor's comment: The use of alcohol can increase the risk of HIV and AIDS. See Alcohol - Immune system and AIDS on this Web site.
{“Never Too Old,” Washington Post Health, July 17, 2001}
Ten to thirty percent of older people may be unable to absorb natural B-12 from food.
{“Women’s Health Advisor,” Weill Medical College of Cornell University, June 2001} Author’s Comment: Alcohol use contributes to this depletion.
Alcohol dries out the mouth and contributes to bad breath.
{Prevention Magazine, 1998}
With aging there is less saliva which causes dry mouth and digestion is less efficient (alcohol is also drying). With aging there is decreased temperature sensitivity and sensitivity to pain which increases the risk of injury (alcohol makes this worse). There is a slow steady decrease in immunity after young adulthood - fewer of the protective antibodies, more infections. Immunizations may be less effective and protection may not last as long as expected.
{“Aging” on healthcentral.com June 2003}
Alcohol - Falls and Hip Fractures
Falls: if you want to avoid a nursing home, avoid falling. A Yale study suggests that preventing falls may reduce the number of admissions to nursing homes, and prevents an individual’s loss of independence and confidence, lack of privacy, and high costs that often follow.
{Tufts University Health and Nutrition Letter, Feb. 1998} Editor's comment: Eliminating alcohol use reduces your risk of falling.
In the U.S., more than 340,000 times a year an elderly person falls and breaks a hip, and their life is changed forever. Often, a hip fracture “is a major life event that may spell the beginning of the end” for an elderly patient, said Dr. Joseph Zuckerman, a New York bone specialist. One in four such patients die within a year, and for those who make it to rehabilitation, about half never recover the ability to walk alone and about 40% must move permanently into a long-term facility. Editor's comment: When consuming alcohol, this risk is increased.
One out of three people 65 years and older fall each year {New England Journal of Medicine}, and of those who fall, 20 to 30 percent suffer moderate to severe injuries that reduce mobility and independence, and increase the risk of premature death {American Journal of Public Health}.
{Center for Disease Control and Prevention - 2000} Editor's comment: Any alcohol use impairs mobility. One alcoholic drink (sometimes less, especially for the elderly) doubles the risk for an accident.
Each year thee are 290,000 Americans who get hip replacements, and 67% are done on those over 65.
{MSNBC - Health, March 2000}
Keeping balanced while walking or standing becomes more difficult with age, and alcohol makes the problem worse. Falls and other injuries are more common with alcohol use. Reaction time slows down with age, and alcohol slows it even more.
{"Alcohol and Aging," St. Vincent's Medical Center, stvincents.org - Nov. 2001}
In regard to the effects of alcohol on sleep and driving: Older persons are known to have a widespread complaint of insomnia and sleep disturbances, and this, with the changes in driving performance of those who are aging drivers, have major pubic health implications.
--- Exercise ---
Exercise and alcohol do not mix. Alcohol is a depressant and will slow physiological and psychological systems which retard performance. The use of alcohol increases the risk of injury, can hinder accuracy, balance, hand-eye coordination, reaction time and general coordination.
{American College of Sportsmedicine, “Fitness,” Parade Magazine, Sept. 9, 1990} Editor's comment: Reaction time, balance, general coordination and accuracy are needed even when not exercising.
More Facts from Drug Awareness and Health Agencies
that Would Affect Seniors
- The effects of alcohol often are dose-related. In other words, smaller amounts cause less harm and greater amounts cause more harm. However, there is no amount of alcohol that is without risk.
- As many as 80% of people over 65 report frequent urination. (Alcohol is a bladder irritant.)
- Avoid alcohol in hot and cold weather, and during exercise. Adults over 55 have a less efficient body thermostat and thirst monitor. Alcohol increases water elimination and the dehydrating effects of the alcohol can impair the body’s ability to sweat properly and cool down.
- Seniors who drive should be aware not only of the impairment of any alcohol use, but that this impairment can last for many hours after blood alcohol concentration returns to normal.
- With age, calcium and other nutrients are absorbed less efficiently. (See Alcohol - Vitamins on this Web site - there are problems when mixing vitamins and alcohol.)
- Stay away from any substance that may alter your judgment or behavior, and you will never have to worry about how much is too much.
{Ann Lander's advice in her column, Oct. 1995} - Although some studies show that lesser amounts of alcohol may lower the risk of ischemic strokes, even light drinking can double the risk of hemorrhagic strokes, and be harmful for the heart. (See Alcohol - Heart on this Web site)
- The Alliance for Aging Research warned of alcohol use depleting the body of antioxidants and the resulting danger to the eyes. To protect the eyes, limit the intake of alcohol.
- Even in healthy people, the liver’s size decreases by nearly 40% between the ages of 20 and 90, so in the average person over 65, age-related liver changes reduce the tolerance of many drugs by 30 to 50%.
{U.S. Pharmacist 1994} Editor's comment: Since the liver is busy processing chemicals and medications for seniors much of the time, it may be a wise choice to eliminate an additional drug: alcohol. - Health and drug awareness agencies warn of any alcohol use when experiencing depression, as it makes the depression worse, or can cause depression.
- Women on oral estrogen replacement who drank one-half glass of wine nearly doubled levels of estrogen circulating in their blood {JAMA).
- The use of alcohol can make allergies, arthritis, fatigue, and anxiety worse.
- Alcohol consumption increases the risk of cancer, addiction, headaches, kidney and bladder problems, and it also increases blood pressure and triglycerides.
- Alcohol lowers the immune system and compromises brain functioning. (When alcohol is present, the brain receives less oxygen).
- Alcohol use interferes with restful sleep, and leads to weight gain.
- Alcohol is the strongest and most toxic of all the common psychoactive substances, and it has negative effects, as well as supposed benefits, for the heart.
- When alcohol is present in the body, it can render medical tests inaccurate.
"Double Whammies" - The Cascade Effects of Alcohol Use
The following “Double Whammies” can occur even when smaller amounts of alcohol are consumed. “Double Whammies” happen when one area of health is adversely affected because of alcohol use, resulting in other areas also being negatively affected. For example, when alcohol consumption causes a decrease in restful sleep, studies show that not having adequate sleep can hasten aging and increase some diseases, like diabetes. It can also cause a reduced production of thyroid stimulating hormone and an increased blood level of cortisol which is associated with memory impairment.
The use of alcohol contributes to weight gain and increases the chance you will be a smoker, and then plays havoc with self-discipline and will-power when trying to lose weight or quit smoking. Alcohol consumption increases the risk of osteoporosis which results in the likelihood of falls and accidents, which can be from a bone breaking and causing the fall, and alcohol use alone increases the risk of falls.
In depression, which is the most common serious brain disease in the U.S., the neural circuits responsible for the regulation of moods, thinking, sleep, appetite, and behavior fail to function properly, and critical neurotransmitters are out of balance. Alcohol can be the cause of these symptoms in some people, or worsen the symptoms already present. The following illnesses are thought to be connected to the development of depressive symptoms: nervous system disorders, vitamin deficiencies, congestive heart failure, strokes, infectious hepatitis and endrocrine disorders (such as diabetes), all of which are negatively affected by the use of alcohol. The many health problems caused from alcohol use: indigestion, depression, anxiety, fatigue, lowered immunity, elevated triglycerides, etc., can result in unnecessary medical tests and medications, not to mention the stress and extra expense involved.
Effect of a Single Drink
Anderson Spickard, MD, in his book, “Dying for a Drink,” says a person can be regularly intoxicated on one glass of wine or beer a day.
A given alcohol dose, even a single drink, can produce higher BACs in older people than in younger. The main factor appears to be the increase in body fat relative to muscle that generally occurs with increasing age. Compared to 25 year-olds, the percent of body weight consisting of fat increases an average of 50% in 60 year old women, and 100% in 60 year old men. Some evidence suggests that even with an equivalent BAC there is a greater impact on an older person’s physiological system than that of a younger person.
{Atkinson 1990}
For children, ingesting even a small amount of alcohol can be deadly says Alan Woolf, MD, Director of the Massachusetts Poison Center at Boston’s Children’s Hospital. When parents and guests drink alcohol, children see it as harmless and can be tempted to sample the left-over drinks that are left unattended. Alcohol should be locked up if it could be accessible to children or grandchildren. (Also be aware of alcohol in substances like vanilla extract, cologne, perfume, etc.)
Any drinking that impairs one’s abilities is drinking “excessively.”
{‘Focus on Healthy Aging,’ Mount Sinai School of Medicine, August 2001}
To help balance the media’s pro-alcohol reporting, I would suggest your reading The Effect of One Alcohol Drink and Health Benefits of Alcohol Questioned and other information on this Web site - this includes wine, beer and spirits. When reporting studies, the media often minimizes any risks from alcohol use and maximizes any benefits, or omits important information given by the researchers which influences the public to think of alcohol as healthy. The public deserves better balanced, more responsible reporting.
Suicide among Senior Citizens
Most Americans are unaware of the high rate of suicide among senior citizens, and researchers at the University of Iowa College of Medicine have issued a wake-up call for the elderly, their families, caregivers, and physicians. Although older Americans make up about 13 percent of the population, they account for nearly 20 percent of all suicides. (An estimated five million of the 32 million people 65 and older suffer from depression. They are a more determined group to act on suicidal tendencies, and they use more lethal methods).
{"High National Rate of Senior Suicide Gaining Notice," Health World Online - http://healthy.net - July 2002} Editor's comment: Alcohol causes/makes depression worse, and makes it more likely that a person would commit suicide. See Alcohol - Anxiety, Depression, and Suicide for more information.