Patterns of Drinking Among Older People

Three patterns of late life alcohol misuse have been described:  

• Survivors (early onset users): often develop alcohol use disorder (AUD) in their 20s, and prematurely age as they do not use preventative services and may require aged care related services in their 50s. 
• Maintainers: their long term alcohol misuse only starts to manifest itself as an overt problem as age-related changes occur and previously well-tolerated, albeit excessive, consumption of alcohol is no longer tolerated or results in harm. 
• Reactors (late onset users): tend to develop alcohol use disorders after the age of 50 and this may occur in association with issues such as declining health, chronic pain, stress, insomnia, bereavement, unemployment, depression, social isolation and boredom. 

Age-related physiological changes result in older adults having a lower tolerance for alcohol than younger adults. Older adults tend to have higher blood alcohol levels than younger adults after consuming the same amount of alcohol. Factors that contribute to this include an increased body fat ratio, slower alcohol metabolism due to decreased levels of the alcohol dehydrogenase enzyme, and a decrease in total body water with age. Thus, older adults have a higher sensitivity to alcohol and a decreased ability to metabolise it effectively.