Health Risks and Comorbidities of Alcohol Use in Older Adults

Older adults require special consideration due to a combination of their lower tolerance of alcohol from age-related physiological changes, the impact of long term alcohol use on health, the increased risk of coincidental health comorbidities and medication use with age, and the impact that these factors have upon their independent functioning and social interactions.   

Physical Health:  

• Numerous physical health complications of alcohol misuse have been well-described including alcohol-related liver disease, cardiac disorders, gastrointestinal disorders, and neurological disorders.  
• Older adults who consume alcohol are more likely to have injurious falls, and die in motor vehicle accidents than those who do not drink. 
• In some cases, existing chronic conditions such as chronic pain may lead to an increase in alcohol consumption.  
• Older adults with long term alcohol use are at increased risk of developing various cancers.  
• The high rates of physical comorbidity in older people is associated with increased use of prescription drugs many of which have known interactions with alcohol with some being contraindicated see Chapter 20).  

Mental Health:  

• Depression is associated with alcohol use.  
• Alcohol misuse is associated with suicidal behaviour in older adults although the risk declines with age.    
• Other mental health impacts of late life alcohol misuse include anxiety disorders, post-traumatic stress disorder, antisocial personality disorders, global psychological distress and increased length of stay of mental health admissions. 

Psychotropic and Illicit Drug Use:  

• Older adults with alcohol use disorders are frequently prescribed sedative-hypnotic, anxiolytic and antidepressant drugs and are more likely to use illicit drugs see (Chapter 20).  

Cognitive Impairment:   

• Light to moderate alcohol consumption in mid to late life does not appear to increase the risk of developing dementia nor is a protective factor for dementia. 
• In contrast heavy alcohol consumption in mid to late life is associated with cognitive decline and increased risk of developing primary dementia and alcohol-related brain damage.
• In some cases heavy alcohol use can develop in the context of primary dementia in older adults with no history of AUD, as they forget how much they have had to drink.  
• Heavy alcohol consumption in people with primary dementia is associated with increased hospital admissions for falls, head injuries and behavioural concerns.