Alcohol consumption and the elderly, do adult responsible ... - AIM
For more information please email Helena.Conibear@aim-digest.com or Alison.Rees@aim-digest.comAlcohol consumption and the elderly, do adult responsible drinkingguidelines apply?by Dr Erik Skovenborg, The Scandinavian Medical Alcohol BoardThe Royal College of Psychiatrists in Londonpublished a report in June relating primarily toproblems of unrecognized alcohol misuse amongthe elderly. The report provides guidelinesfor psychiatrists and family physicians on howto find and how to treat elderly people whomisuse alcohol and drugs 1 . A few pages of thelengthy report, however, concern the evidencebase for a proposed reduction of sensible limitsof alcohol intake for older people and state:“Current recommended ‘safe limits’ for alcoholconsumption are based on work in youngeradults. Because of physiological and metabolicchanges associated with ageing, these ‘safe limits’are too high for older people; recent evidencesuggests that the upper ‘safe limit’ for olderpeople is 1.5 units per day or 11 units per week. Inolder people, binge drinking should be defined as>4.5 units in a single session for men and >3 unitsfor women.”A UK unit is 10 ml or 8 grams of pure alcohol andThe Royal College of Psychiatrists’ suggestions forsensible limits for older people are in accordancewith the recommendations from the AmericanGeriatrics Society 2 and the National Institute onAlcohol Abuse and Alcoholism 3 . The Americanorganisations recommend that older adults whohave no contraindications to alcohol use limittheir intake to no more than one drink per day.One American Standard Unit of Alcohol is 18 ml or14 grams of pure alcohol.Is there an evidence base to justify thesereduced daily guidelines for healthy elderlyconsumers?Coronary heart disease is the leading causeof death in older people, and the obviouscoronary health benefits of a moderate alcoholconsumption found in several large populationstudies highlight the considerable difficulty inbalancing the apparent risks and benefits ofalcohol use. Even though very little is knownabout the potential for a social movementbacklash if a guideline is perceived as overlyrestrictive, the repeatedly demonstrated benefitsof a light to moderate alcohol intake call for anupdated and realistic evaluation of the potentialrisks and benefits of alcohol consumption beyondone drink per day in the elderly population.Alcohol metabolism and tolerance in olderpeopleThe National Institute on Alcohol Abuse andAlcoholism and The Royal College of Psychiatristsclassifies greater intake than 14 grams of purealcohol per day as at-risk drinking for olderpeople, partly because of the greater sensitivityof older adults to the physiological effects ofalcohol. Among the physiological and metabolicchanges associated with ageing and decreasingalcohol tolerance, dwindling body water is themost important problem according to NIAAA.“Between the ages of 25 and 60, the proportionof total body weight represented by fat almostdoubles in men and increases by 50% in women.As lean body mass diminishes and adiposetissue increases, the volume of total body waterdecreases. Because of the dramatic changes inbody fat and lean body mass among men as theyage, for older men no more than one drink a day isa more prudent definition of moderate” 4 .The issue of dwindling body water through theyearsMary Dufour et al quote a Canadian monograph“Drugs and Aging” for the problem of dwindlingbody water through the years 5 . The issue ofbody water is discussed in the chapter “Age-Related Changes” with a reference on page 9 toan old investigation from Rochester, USA, wherethe volume of lean body mass was estimatedfrom repeated assays of 40K isotope counting. 6Longitudinal observations on body weight andestimated lean body mass for six male subjectsfrom Rochester showed a decline in lean bodymass in four, an increase in one subject and theAlcohol consumption and the elderly, do adult responsible drinking guidelines apply?