Alcohol and the Older Brain

Alcohol is the most common addictive substance used among older adults. Approximately

50 percent of men and 40 percent of women age 60 or older drink alcohol on a regular basis. There is a large body of research to suggest that alcohol in small amounts can be healthy. The cardiovascular benefits of red wine with its flavonoids and antioxidants, in particular, have been shown to improve heart and brain health. In contrast, “at-risk drinking,” defined as more than three drinks in one day or seven drinks per week in older adults, can have the opposite effect, including:

• Increased risk of hypertension, cardiac arrhythmia and myocardial infarction
• Increased risk of stroke
• Impaired immune system
• Decreased bone density
• Liver diseases including cirrhosis
• Gastrointestinal bleeding
• Depression

After drinking the same amount of alcohol, older adults have higher blood alcohol levels than younger people. This is due to a decrease in muscle mass and reduced functioning of the liver and kidneys. These age-related changes slow the body’s ability to process and excrete alcohol. So, alcohol remains in the bloodstream longer. As the brain ages, the blood-brain barrier weakens, making the brain more vulnerable to the toxic effects of alcohol.

Moderate to high alcohol consumption in middle and older age can result in cognitive impairment and dementia in later life. One study found a five times greater risk of dementia in men over 65 with a 15-plus year history of heavy drinking. Research suggests that older adults have less awareness of the effects of alcohol on their judgment than younger adults, which may make it harder to know your “new” limit. For example, it may lead someone to think that they are capable of driving after three drinks, whereas previously they felt they could drive safely after three.

Older adults are at higher risk for dangerous alcohol–medication interactions. The combination of alcohol and benzodiazepines, antidepressants, pain medications, sleeping pills and cold/flu medications are particularly unsafe. Alcohol may decrease the effectiveness of drugs or intensify side effects, including dizziness or loss of coordination, making falls or car accidents more likely.

The bottom line:

• If you don’t drink, don’t start. If you do drink, enjoy alcohol in small amounts. Per the guidelines, this means no more than three drinks per day and seven total drinks per week. Each drink should be equivalent to 12 ounces of beer, 1.5 ounces of liquor, or 5 ounces of wine.
• Sensitivity changes. Recognize that your sensitivity to alcohol may have increased so you may not need as much as you once did to enjoy the benefits.
• Read your medication labels and follow the directions. Ask your doctor or a trusted pharmacist if you should drink alcohol while taking a particular medicine. For more information, download the free guide “A Guide to Aging, Medicines and Alcohol” here: http://store.samhsa.gov/product/As-You-Age-A-Guide-to-Aging-Medicines-and-Alcohol/SMA04-3940
• It’s never too late to reduce or stop drinking if you think you have a problem. The brain can recover remarkably well from years of too much drinking in many people with prolonged abstinence. If you need support, ask your doctor, spouse or a friend for help.