The more you age, the more you need to limit liquor

I typically have a second glass of wine when I'm out to dinner, either at a friend's house or a restaurant. But as I get older, I may need to reconsider that practice.

That's because as we age, our bodies react to alcohol differently. As a result, guidelines from the National Institute on Alcohol Abuse and Alcoholism are more restrictive for older people than those for younger adults.

“Because of changes in normal aging, we become more sensitive to the effects of alcohol,” says Alison Moore, a UCLA geriatrician who researches drinking behaviors in older adults.

For men in general, the NIAAA recommends no more than 14 drinks per week and no more than four drinks on a given day. (For women, the numbers are seven and three.)

For people older than 65 who are healthy and don't take medications, the NIAAA guidelines say no more than seven drinks per week and no more than three drinks on any one day. (One drink equals 12 ounces of beer, five ounces of wine or 1.5 ounces of liquor. )

If seniors drink more than that, Moore says, they put themselves at increased risk for alcohol-related problems. This may mean thinking less clearly, forgetting things and falling. Even subtle impairments can interfere with normal activities such as cooking and remembering to take medications.

There are a number of reasons why drinking is riskier in the elderly.

Older people have less muscle mass and less water content, which means more alcohol ends up circulating in the blood. Also, older people metabolize alcohol more slowly, so that its effects last longer. An enzyme called alcohol dehydrogenase, or ADH, is needed to begin breaking down alcohol. As the enzyme acts, alcohol's effects decline.

“When we age, starting at around age 50, we start to lose ADH,” says Alexis Kuerbis, a social worker at New York's Hunter College who specializes in alcohol use disorders in older adults.

(ADH also accounts for the gender difference in alcohol effects. Women, on average, have half the amount of the enzyme as men, according to Kuerbis.)

Altogether, this means that a 60- or 70-year-old can develop a drinking problem even if his or her drinking habits haven't changed in decades.

And even if you drink less, your older brain will be more sensitive to alcohol, says Sara Nixon, a psychologist who studies aging and alcohol effects at the University of Florida. Nixon finds subtle effects on cognitive abilities among older people who drink moderately.

For instance, in a 2014 study, volunteers were given alcohol to achieve blood alcohol concentrations of either 0.04 percent or 0.065 percent — less than the 0.08 level that classifies a driver as intoxicated — and tested in a driving simulator. At the higher level, people age 55 to 70 were more erratic with their steering and were worse at maintaining a consistent speed than younger volunteers, who showed no significant impairment.

So in the not-too-distant future, even my first glass of wine may affect my reactions and coordination more than it did when I was younger.

“Acute bouts of drinking carry some risk, and people need to be aware of that,” Nixon says. Even moderate drinkers may need to reconsider their drinking habits, she said.

“About half the people over the age of 65 consume alcohol,” Moore says, and of those people, about 10 to 15 percent drink at a level that exceeds the NIAAA guidelines, which puts them at risk for negative consequences.

Most people reduce or quit drinking as they get older, often because of worsening health. Seniors who drink heavily often were heavy drinkers as younger adults: They're maintaining their habit with potentially worse results. Still others develop heavy drinking habits late in life, Moore says, “because of loss. They're retired, they're lonely, they've lost a loved one _ they've had a negative change in life.”

What if an older person in your life is drinking too much?

Encourage him to see his doctor, who should regularly screen for problem drinking. Kuerbis says physician education on this has gotten better in recent years. Moore says adult children often raise concerns about alcohol to their parents' doctors.

“Studies do show that age-specific treatment is best for older adults,” Kuerbis says. That means group sessions with people of similar age or therapies that take into account seniors' cognitive abilities.

Psychologists employ what is called a motivational interview to get someone to consider changing his or her drinking behavior. This means talking through the consequences of drinking — making a health condition worse or getting poor sleep or not keeping up with life's responsibilities. “If they see that the substance causes problems, they may be motivated to cut back on drinking,” Moore says.

Still, the problem can be intractable. Kuerbis describes two patients — “some of the heaviest drinkers I ever witnessed,” she says. They were retired, they weren't caring for anyone but themselves, and they had no responsibilities. “They had zero motivation to change.”

Loved ones can sometimes help with motivation, Kuerbis says. Keep it nonconfrontational. Emphasize that you want your parent or your aunt to have as much quality of life and independence as possible.

The Hazelden Betty Ford Foundation offers information about older people and drinking at www.hazeldenbettyford.org.