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Alcohol and Health - Alcohol and Aging|
There is a tremendous diversity within the group considered ‘elderly’, and generalizations are most often misleading. The age range of the group spans at least 40 years and includes people in their late sixties, who are still actively employed and in excellent health, as well as people over 100 years of age, who are more likely to be cognitively and physically disabled. Moreover, we all age at different rates, but it is physiologic ageing - such as the modest 10-15% reduction of total body water as humans age - that underlies age-related differences in the action of alcohol on our bodies. Health status is closely related to the ageing process. The biological process of ageing reflects the interactions between our genetic inheritance and environmental influences. The ageing process includes progressive and irreversible biological changes, resulting in a growing risk of chronic diseases, cognitive impairments and an impairment of functions. In the Alameda County Study long-term predictors of healthy ageing and high levels of physical functioning were: higher family income level, absence of hypertension, absence of arthritis, absence of back pain, being a non-smoker, having normal weight, and consuming moderate amounts of alcohol. With sound advise to hand, each individual must decide whether or not to consume alcohol and, if alcohol is consumed, what level and pattern is appropriate - at meal times is best. The relation between levels of drinking and all-cause mortality will vary depending on a person’s underlying risk of various causes of death. The groups most likely to benefit from drinking small amounts of alcohol are older people at high absolute risk of coronary heart disease and ischemic stroke and at low absolute risk of injury, cirrhosis and other alcohol-related disease. (Jackson R et al. Alcohol consumption guidelines: relative vs absolute risks and benefits. BMJ 1995;346:716.). This hypothesis was confirmed by the results of a meta-analysis of the risk curve between alcohol and all-cause mortality: The older the persons at baseline, the more pronounced the protective effect. (Gmel G et al. How stable is the risk curve between alcohol and all-cause mortality and what factors influence the shape? A precision-weighted hierarchical meta-analysis. Eur J Epidemiol 2003;18:631-42). Most protection of health seems to be conveyed by a pattern of very regular and light drinking, however, health is only one aspect in this decision. Most people do not drink for health reasons but for psychological and social benefits, since alcohol serves as a mood modifier, a relaxant, and a social lubricant. No one should be choosing to drink for medical benefits rather than enjoyment and pleasure. The US 2010 Guidelines state :'An average daily intake of one to two alcoholic beverages is associated with the lowest all-cause mortality and a low risk of diabetes and CHD among middle-aged and older adults. Despite this overall benefit of moderate alcohol consumption, the evidence for a positive association between alcohol consumption and risk of unintentional injuries and breast and colon cancer should be taken into consideration. The DGAC recommends that if alcohol is consumed, it should be consumed in moderation, and only by adults... |
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Coronary heart disease Coronary heart disease is the leading cause of death in older people, and the obvious coronary health benefits of a moderate alcohol consumption found in several large population studies ( see more link to alcohol and the heart area) highlight the considerable difficulty in balancing the apparent risks and benefits of alcohol use and the greater sensitivity of older adults to the physiological effects of alcohol. Although we do not advocate that anyone take up moderate drinking alcohol for health reasons,The UK Government guidelines explain that middle aged or elderly non-drinkers or infrequent drinkers and especially those at risk for heart disease ‘may wish to consider the possibility that light drinking may be of benefit to their overall health and life expectancy'. Hypertension Hypertension is associated with a doubled risk for cardiovascular disease and may account for 30% of events associated with cardiovascular disease. (Wilson PW et al. Prediction of coronary heart disease using risk factors categories. Circulation 1998;97:1837-47.) The risk relationship between alcohol consumption and hypertension may best be described as a threshold effect : little increase in risk is found up to about 20-30g of alcohol per day, beyond which blood pressure increases markedly. At a drinking level of 30g or more a day (two US and Canadian drinks and three UK drinks), a net harm is seen in epidemiological studies. Heart Failure Heart Failure (HF) is one of the leading causes of hospitalization of the elderly. In the New Haven EPESE cohort study of 2235 elderly persons (mean age 73.7 years) consumption of about 1.5 to 2 drinks per day was associated with a significantly reduced risk of HF: relative risk 0.53 (CI 0.32-0.88) compared with non-drinkers. (Abramson JL et al. Moderate alcohol consumption and risk of heart failure among older persons. JAMA 2001;285:1971-77.) A meta-analysis of data from 6 studies suggest that infrequent and light-to-moderate drinking is associated with a lower risk of heart failure. (Padilla H et al. Alcohol consumption and risk of heart failure. A meta-analysis. The Physician and Sports medicine 2010;38:84-89.) However, long-term heavy alcohol consumption has been associated with worsening cardiac function, and chronic alcoholism is one of the most important causes of dilated cardiomyopathy. (Rubin E et al. Alcoholic cardiomyopathy. Alcohol Clin Exp Res 1994;18:111-4). Alcohol use and successful aging Among 13,894 women in the Nurses’ Health Study, investigators prospectively examined alcohol use assessed at midlife in relation to ‘successful ageing’, which was defined as survival to age 70 years, not having a major chronic disease (such as coronary disease, cancer, stroke, diabetes), and having no major cognitive impairment, physical impairment, or mental health problems. Only 11% of the women met these criteria. The results indicate that moderate drinkers, especially those consuming wine and drinking regularly, were more likely to exhibit successful ageing. For average amount consumed, the largest benefit (an increase of 28%) was among women who reported 15.1 30 g of alcohol per day (an average of just over 1 to 2
Alcohol and dementia As well as the ‘heart-healthy’ benefits of moderate drinking to older people, research is also finding that moderate alcohol consumption may reduce the risk of dementia and Alzheimer’s disease. Heavy alcohol consumption will, however, cause neural damage and memory loss. The benefit of moderate alcohol for cognition has been shown in both men and women, although the amount and pattern of drinking is very different between the two sexes). A recent meta-analysis of 143 papers describing the relative drinking of alcohol and cognition found that moderate drinking seems to reduce the risk of dementia and cognitive decline in older subjects. (Neuropsychiatric Disease and Treatment 2011;7:465-84.) Heavy alcohol use has a significant and negative effect on everyday cognitive performance, and the presence of cognitive and neuropsychological deficits have been observed in heavy drinkers. (Ling T et al. Effects of alcohol on subjective ratings of prospective and everyday memory deficits. Alcohol Clin Exp Res 2003:27:970-74.). Long-term abuse of alcohol is associated with alcohol dementia. (Wernicke-Korsakoffs Syndrome). Alcoholic beverage consumption may exacerbate cognitive impairment and dementias due to other causes, and recognition of heavy alcohol consumption in cognitively impaired patients is important, as chronic alcohol toxicity represents one cause of potentially reversible dementia. Alcohol use and bone strength Abuse of alcohol is considered to be an important risk factor for fractures and osteoporosis (Laitinen K et al. Alcohol and bone. Calcif Tissue Int 1991; [Suppl] 49:S70-S73.), however, mounting epidemiological evidence indicates a positive association between moderate intake of alcoholic beverages and higher bone mineral density. (Jugdaohsingh MA et al. Moderate alcohol consumption and increased bone mineral density: potential ethanol and non-ethanol mechanisms. Proceedings of the Nutrition Society 2006;65:1-20.) Click here to read "Alcohol consumption and the elderly, do adult responsible drinking guidelines apply?" a summary paper by Erik Skovenborg of Scandinavian Medical Alcohol Board |
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