Diana N Pure, PhD
Miami VA Healthcare System
Presented at MAGEC MH IGT
June 2013
Risky Drinking in
an Aging
Populations
Diana N Pure, PhD
Miami VA Healthcare System
Presented at MAGEC MH IGT
June 2013
Risky Drinking in
an Aging
Populations
Vicki Brail, LCSW
Professional Guardian
National Certified Geriatric Care Manager
Attending to
the Needs of
an Aging LGBT
Population
Drinking in America
More than 75,000 deaths are attributable to alcohol
consumption each year, and alcohol-related
problems go far beyond the traffic injuries and
fatalities, alcohol poisoning, violence, risky sexual
behaviors, physical addiction, and irreversible liver
damage associated with heavy drinking. Over time,
even mildly excessive alcohol use can lead to the
development of chronic diseases, neurological
impairments, and social problems. These include, but
are not limited to dementia, depression, anxiety,
stroke, heart disease, respiratory & vascular problems,
cancer, falls, and a host of other unintentional injuries
and interpersonal problems.
Who Drinks & How Much
While there are many positive impressions
created by alcohol advertising and popular
culture, Americans are becoming increasingly
conscious of the problems created by alcohol.
A large majority of Americans either do not drink
at all or drink infrequently. According to the
National Survey on Drug Use and Health, about
46% of adults reported that they did not
consume any alcohol in the past month and an
additional 31% reported drinking once a week
or less.
The Numbers…
By Percentage…
What is LOW Risk
Drinking?NIAAA Recommends:
NIAAA Standards & Gender
Research shows that women start to have
alcohol-related problems at lower drinking levels
than men do. One reason is that, on average,
women weigh less than men. In addition,
however, alcohol disperses in body water, and
pound for pound, women have less water in
their bodies than men do. So after a man and
woman of the same weight drink the same
amount, of alcohol, the woman's blood alcohol
concentration will tend to be higher, putting her
at greater risk for harm.
Low-Risk is NOT No-Risk
Even within these limits, drinkers can
have problems if they drink too
quickly or have health problems.
Based on general health and how
alcohol affects the individual, he or
she may need to drink less or not at
all.
Identifying Risky Drinking
Risky drinking patterns include high-volume drinking, high-quantity
consumption, and even ANY consumption if various medical or
situational factors exist.



High-volume drinking: 14 or more standard drinks per week on average
for males, and 7 or more standard drinks for females.
High-quantity consumption: Consumption on any given day of 5 or
more standard drinks for males, and 4 or more standard drinks for
females.
Any consumption within certain contexts: Even when small quantities of
alcohol are ingested, drinking is risky if it occurs in contexts that pose a
particular danger such as:
 During pregnancy,
 When certain health conditions are present,
 When certain medications are taken, or
 Prior to operating machinery, driving, or engaging in other activities
that demand your full attention.
NIAA Guidelines for
Persons of Age
Both men and women over 65 are
generally advised to have no more than 3
drinks on any day and 7 per week.
What is a Standard Drink?

A standard drink is any drink containing 10
grams of alcohol.


One standard drink always contains the same
amount of alcohol regardless of container size
or alcohol type (i.e., beer, wine, or spirits).
A standard drink is a unit of measurement. In the
same way one meter measures a particular
distance travelled, one standard drink measures
a particular amount of alcohol consumed.
A Standard Drink?
 One
Standard Drink (SD) = 10 gm alcohol
 The amount of Alcohol per Volume varies
from drink to drink:
E.g.


Full Strength Beer
Wine
= 4.9% by Volume
= 12% by Volume
A Standard Drink?
 One


Standard Drink for:
Full strength beer = 204 mls
Wine
= 83 mls
 But
alcohol is not sold in those amounts.
 A guide helps to calculate how many
SD’s there are in usual alcoholic drinks.
A short guide to Standard Drinks
Description
Alcohol/volume
Volume
Standard Drinks
average
restaurant
serve of
wine
12%
full
strength
beer
pre-mix
spirits
4.9%
5%
180ml
375ml
375ml
1.8
1.5
1.5
Standard Drink Guide
A full guide to standard drinks in
a serving of alcohol is available
at:
www.rethinkingdrinking.niaaa.nih.gov
What ARE the General Risks?
You may have heard that regular light to moderate drinking can be
good for the heart. With heavy or at-risk drinking, however, any
potential benefits are outweighed by greater risks, including
Injuries.
Drinking too much increases your chances of being injured or even
killed. Alcohol is a factor, for example, in about 60% of fatal burn injuries,
drownings, and homicides; 50% of severe trauma injuries and sexual assaults;
and 40% of fatal motor vehicle crashes, suicides, and fatal falls.
Health
problems. Heavy drinkers have a greater risk of liver disease, heart
disease, sleep disorders, depression, stroke, bleeding from the stomach,
sexually transmitted infections from unsafe sex, and several types of cancer.
They may have problems managing diabetes, high blood pressure, and other
conditions.
Birth
defects. Drinking during pregnancy can cause brain damage and other
serious problems in the baby. Because it is not yet known whether any amount
of alcohol is safe for a developing baby, women who are pregnant or may
become pregnant should not drink.
What ARE the General Risks?
(continued)


Alcohol use disorders. Generally known as alcoholism and alcohol abuse,
alcohol use disorders are medical conditions that doctors can diagnose when
a patient's drinking causes distress or harm. In the United States, about 18
million people have an alcohol use disorder.
Beyond these physical and mental health risks, frequent heavy drinking also is
linked with personal problems, including losing a driver's license and having
relationship troubles.
Aging & Drinking
Due to age-related changes in body
composition, equivalent amounts of alcohol
produce higher blood alcohol concentrations
in older people (Reid & Anderson, 1997).
At extreme risk are persons with a history of
substance disorders and those with co-morbid
mental illness.
At-Risk Drinking, Cultural
Considerations, &
Demographics
The ‘baby boom’ generation has higher rates of
lifetime alcohol and drug use than did the
previous generation, and evidence suggests
that these higher rates will persist as the group
ages (NHSDA, 2000).
OOPS!
The risks of drinking increase just as the
likelihood of drinking increases!



Alcohol use may increase in elderly people in the
context of bereavement, changing role, or illness
(O’Connell, Chin, Cunningham, & Lawlor, 2003).
Alcohol may be used to relieve the boredom or
depression stemming from unfulfilled expectations.
Losses such as a decline in economic status, the
death of a spouse or close friends, and deterioration
of health with worsening medical problems, are all
risk factors for drinking in the elderly; alcohol may be
used to reduce psychological, emotional, or physical
stress (Menninger, 2002)
Risks Magnified in Elderly Persons













Increased Risk of Accidents & Falls
High Blood Pressure
Stomach Pain
Weight Gain
Sexual Performance Problems
Difficulty Sleeping
Malnutrition
Presence of medical conditions aggravated by
alcohol, including diabetes
Reduced Effectiveness of Medication
Increased Side Effects of Medication
Alcohol/Medication Interactions
Social isolation
Financial Problems
Helping Clients Cut Down
on Drinking #1
1.
2.
3.
4.
Educate
Address the REAL issue
Help the client make use of tools to assess
drinking patterns
Assist in changing these patterns as needed
Helping Clients Cut Down on
Drinking #2
“Do YOU drink in excess of the
recommended guidelines? Reasons
to cut down on drinking are sure to
be different for different people.”
The slide that follows contains a list of
frequently-identified reasons to quit or cut
down. Encourage clients to identify the 3
most important reasons THEY want to
change their drinking patterns. Perhaps
they can think of other reasons that do not
appear on this list...
Oft-Identified Reasons to
Reduce Alcohol Intake








To consume fewer empty calories.
To enjoy a better sex life.
To sleep better.
To feel better.
To save money.
To be happier.
To reduce the likelihood of accidents & mishaps.
To have better relationships with family, friends,
and/or community.
Questions?
Comments?
Experiences?