In the elderly, excessive alcohol consumption can have deleterious effects because the physiological changes associated with aging make the elderly particularly vulnerable to the harms of excessive alcohol consumption. On the contrary, a low consumption of red wine reduces the risk of dementia.
Epidemiology
The prevalence of alcohol abuse in the elderly (more than 30 g/day of alcohol) would vary from 2 to 4% in France and the United States. If we take into consideration the more restrictive criteria of the DSM, the prevalence would be around 6% This prevalence is higher among hospitalized elderly people than among those living at home.
According to a study published online July 31, 2019 in the Journal of the American Geriatrics Society, more than one in ten adults ages 65 and older in the United States are occasional heavy drinkers.
Excessive alcohol consumption is defined as the consumption of 5 or more alcoholic beverages on the same occasion for men and 4 or more drinks for women.
« Occasional drinkers were more likely to be male (58%), had a higher prevalence of current tobacco (21%) and/or cannabis (6%) use, and a lower prevalence of at least two chronic conditions (29%) compared to non-occasional drinkers, » says Dr. Benjamin Han of New York University School of Medicine.
The most common chronic diseases among heavy drinkers were hypertension (41.4%), cardiovascular disease (23.1%) and diabetes (17.7%).
These results come from a cross-sectional analysis of more than 10,000 adults aged 65 and over from the US National Survey on Drug Usage and Health (NSDUH).
Profile of alcoholism in the elderly
Old alcoholism concerns two thirds of the elderly. Late alcoholism is often due to stressful life events (e.g. separation, bereavement, generational conflict, disabling illness) or environmental factors (eg social isolation, celibacy).
Alcoholism and co-morbidity
Alcoholism in the elderly is frequently accompanied by signs and symptoms: repeated falls, walking disorders, confusion, undernutrition, incontinence, reduced psychomotor activity, neglect of personal hygiene.
Disorders related to excessive alcohol consumption are also confused with organic or mental illnesses: hypertension, liver problems, digestive disorders, mood, and sleep disorders (insomnia, nightmares).
Complications of alcoholism
Complications are as follows:
- Falls and accidents;
- Food inconsistency;
- Family issues, including social isolation;
- Adverse health effects.
Alcoholism Assessment
The assessment should include:
- a complete physical examination;
- screening for other signs of alcoholism (e.g. hyperuricemia, gastrointestinal disturbances, high blood pressure, insomnia);
- biology report;
- collection of eating habits;
- assessment of mental state;
- appreciation of the attitude towards aging;
- history of consumption (alcohol, drugs).
Alcohol and decline in mental faculties in the elderly
As we age, the harmful effects of excessive alcohol consumption are more pronounced on key brain functions such as memory, attention and learning, according to US researchers. ‘University of Florida.
Alcohol consumption is considered excessive when:
- A man drinks 4-5 glasses or more in a day, or more than 14 glasses a week.
- A woman drinks 3-4 or more glasses a day, or more than 7 glasses a week.
The latter asked 31 men and 35 women to carry out a series of neuropsychological tests and then were divided into groups according to their alcohol consumption: heavy drinkers, moderate drinkers or non-drinkers.
About 53% of the study group were occasional drinkers, while 21% were considered heavy regular drinkers.
The test results of this last group were compared with the results obtained with 45 non-drinkers and moderate drinkers.
The research team tracked brain functions such as attention, learning, memory, motor function, verbal function and speed of thought, executive function (which includes reasoning and working memory ).
The study found that heavy alcohol consumption in older people resulted in lower scores on tests assessing memory and learning, memory and motor function.
Those who had experienced alcohol addiction also had poor test scores.
The researchers point out that the effects of excessive alcohol consumption can be particularly dangerous for older people, many of whom take multiple medications.
Moderate alcohol consumption and risk of dementia
It is accepted that moderate consumption of alcoholic beverages – and in particular red wine – has preventive effects on cardiovascular diseases in the elderly (such as myocardial infarction, cardiac ischemia, valvular heart disease, arrhythmia and stroke).
Indeed, moderate and regular consumption of alcoholic beverages (1 to 2 glasses per day):
- decreases the risk of atherosclerosis (i.e. the formation of deposits containing cholesterol and lipids in the arteries), by raising the level of high density lipoproteins or HDL (commonly called the « good cholesterol »), and, perhaps, by decreasing that of low-density lipoproteins or LDL (the « bad cholesterol »);
- decreases the risk of thrombosis (aggregation of platelets and fibrin in the blood);
- accelerates fibrinolysis (dissolution of intravascular clots by a degrading enzyme called plasmin) and decreases blood levels of fibrinogen (a protein that promotes coagulation).
It is now accepted that older people with cardiovascular disease are more likely to suffer from cognitive impairment or to suffer from dementia [2] .
Based on this observation, a group of researchers studied the prolonged effects of alcohol consumption on the risk of developing dementia.
The results showed that moderate alcohol consumption (up to 3 drinks per day) significantly reduces the risk of developing dementia, and in particular vascular dementia*.
* Vascular dementia, less frequent than dementia of the Alzheimer type, is the consequence of lesions (single or repeated and of variable magnitude) in the brain, caused by a lack of irrigation.
This effect is more marked in men and does not depend on the type of drink consumed.
These results agree with those published by a Sino-Swedish team [5] .
These results – which are however disputed because of the methodology – are certainly encouraging for moderate drinkers, but beware: we do say « moderate ». And it would be unreasonable to push drinking water drinkers (especially people at risk) who have abstained so far.
This study was carried out on 400 people aged 75 years. Moderate alcohol consumption (calculated by taking the quantity of ethanol present in beverages as the standard unit) corresponds to a maximum of 16g/day for women and 24g/day for men.
For information:
- A bottle of beer (340ml) contains 13g of ethanol
- A standard glass of wine contains 11g of ethanol
- A glass (44ml) of spirits contains 15g of ethanol
Excessive alcohol consumption and risk of ischemic stroke
Preventive up to two glasses a day
Moderate consumption (one to two glasses a day) of alcohol slightly reduces (up to 20%) the risk of stroke of ischemic origin, according to a meta-analysis of around thirty works and published in the journal BMC Medicine in February 2017.
Above 3 to 4 glasses of alcohol per day, alcohol has a deleterious effect, increasing the risk of ischemic stroke.
There is also an increased risk of cancers, cardiovascular diseases and cirrhosis of the liver. Another American study highlights the increased risk (+15%) of breast cancer in women consuming up to six glasses of wine per week.
Finally, this risk also increases when daily consumption exceeds 4 glasses per day.
While low alcohol consumption is associated with a low risk of ischemic stroke, alcoholism on the contrary increases this risk (this is called a J-curve).
If you drink alcohol more than twice a week, your risk of death from stroke increases threefold compared to those who don’t drink alcohol.
Effects that depend on age and frequency
Furthermore, the results show that the effects of alcohol are not limited to the quantity consumed, but also to the frequency of consumption.
In addition, drinking more than 2 glasses of alcohol (including wine) per day in midlife increases the risk of stroke by a third, compared to those who drink little or not at all.
The risk of alcohol on the occurrence of a stroke is higher than that of hypertension and diabetes, at least when consumers are aged 50-60 years.
On the other hand, for people in their 70s, hypertension and diabetes are more important risk factors for stroke than alcoholism.
2609 men participated in this study conducted by Finnish researchers. The men were mature and were followed for 20 years.
Conclusion: consuming more than two glasses of alcohol per day is a risk factor for stroke. This factor varies with age.
Excessive alcohol consumption and risk of hemorrhagic stroke
Consuming more than three to four glasses of alcohol a day after age 60 accelerates brain aging, according to a published study of 137 hospitalized stroke patients. According to researchers from Lille (France), in the sixties, regular (and not excessive) consumption of alcohol weakens the cerebral arteries, which can cause a stroke of hemorrhagic origin (rupture of the ruptured artery).
More specifically, it appears that regular drinkers have cerebral hemorrhages on average 14 years before non-drinkers who suffer a hemorrhagic stroke.
The stroke occurs preferentially in the deep areas of the brain irrigated by small arteries which are the most vulnerable. “One of the authors of the study says that alcohol will make these small vessels more and more rigid and porous.
Another study shows that, beyond two glasses of alcohol per day, the risk of stroke of hemorrhagic origin increases rapidly (+60%)
The fact that the vessels rupture more easily could be explained by the fact that the consumption of alcohol could decrease the levels of fibrinogen, a protein which facilitates the formation of blood clots.
Sources
- The Journal of the American Medical Association, June 2012.
- Neurobiology of Aging, 21, 153-160, 2002.
- The Lancet 359, 281-286, 2002.
- The frequency of alcohol consumption is associated with the stroke mortality. Acta Neurologica Scandinavica, March 2014.
- Differing association of alcohol consumption with different stroke types: a systematic review and meta-analysis. BMC Med. 2016 Nov 24;14(1):178.
- Alcoholism: Clinical and Experimental Research, Sept. 2016.
- Alcohol consumption and incidence of dementia in a community sample aged 75 year and older, Journal of Clinical Epidemiology, 55, 959-964, 2002.