alcohol use in older adults - chapter 15
DESCRIPTION
“The French Paradox” Benefits of red wine Contain substances that appear to prevent blood clots Prevents oxidation of low-density lipoproteins Raises high-density lipoproteins Alcohol Good for the heart and circulatory system Protective against diabetes and gallstonesTRANSCRIPT
Alcohol Use in Older Adults
Chapter 15
Introduction
• “The French Paradox”– Benefits of red wine
• Contain substances that appear to prevent blood clots
• Prevents oxidation of low-density lipoproteins• Raises high-density lipoproteins
• Alcohol– Good for the heart and circulatory system– Protective against diabetes and gallstones
Introduction
• Heavy drinking– Major cause of preventable death
Alcohol and Alcohol Use Defined
• “Moderate” amount– When health benefits outweigh the risks– 1-2 drinks/day for men– 1 drink/day for women
• As a nutrient– Provides 7 Kcal/gram– A food, but not a nutrient– Not stored in body– Acts like a drug
Epidemiology
• Age• Geographic differences• Various alcohol related diseases causing death• Drinking patterns in older adults• Gender
– Men are two times more likely than women to drink excessively
– Women are more vulnerable to the consequences of alcohol use
Epidemiology
• Alcoholism Theories– Biogenetic model – Sociocultural model– Learning theory/behavior model– Psychological-psychodynamic model
• Genetics– First-degree relatives’ share genetic risk factors
Age-Related ChangesAffecting Alcohol Intake
• Physical changes– Body water to fat ratio decreases– Hepatic blood flow decreases– Liver enzymes diminish in efficiency– Increased permeability of blood-brain barrier
Nutritional Intake
• Alcohol adds calories without nutritional benefits
Risk Factors
• Age related problems and chronic health problems
• Physical changes– Less tolerant of alcohol
• Risks and benefits of alcohol consumption with aging
Alcohol, Physiology, and Pathophysiology
• Absorption begins in mouth and esophagus• Primary site of absorption is the small
intestine
Insel P, Turner RE, Ross D. Nutrition. 3rd ed. Sudbury, MA: Jones & Bartlett; 2007, p. 306. Reproduced with permission.
Alcohol, Physiology, and Pathophysiology
• Food delays rate of alcohol absorption• Alcohol metabolism occurs in liver
– Quick metabolism– Fatty liver
• Alcohol has a more serious damaging effect in women compared to men
• Alcohol stimulates appetite
Alcohol, Physiology, and Pathophysiology
• The Brain and Nervous System– Memory impairments can result– Facilitates dopamine transmission– Causes changes in brain’s normal activity– Decline in cognitive and physical function– Hepatic encephalopathy (brain disease)
Alcohol, Physiology, and Pathophysiology
• Vitamin and Nutrient Deficiencies– Decreases absorption of vitamins and minerals
Alcohol, Physiology, and Pathophysiology
• Vitamin and Nutrient Deficiencies
Alcohol and Malnutrition
Insel P, Turner RE, Ross D. Nutrition. 3rd ed. Sudbury, MA: Jones & Bartlett;2007, p. 319. Reproduced with permission.
Alcohol, Physiology, and Pathophysiology
• Vitamin and Nutrient Deficiencies– Thiamine
• Result = impairment of the brain and neurological system
• Risk of Wenicke-Korsakoff syndrome– Folic acid
• Alcohol blocks absorption of folic acid• Chronic alcohol abuse may result in
macrocytosis
Alcohol, Physiology, and Pathophysiology
• Vitamin and Nutrient Deficiencies (cont.)– Hormones
• Drinking one drink per day increases risk for breast cancer up to age 70
• Liver– Alcoholic liver disease
• Fatty liver• Alcoholic hepatitis• Cirrhosis
Alcohol, Physiology, and Pathophysiology
• Liver– Alcoholic liver disease
• Fatty liver• Alcoholic hepatitis• Cirrhosis
–Scarring of the liver–Potentially fatal– Increases the incidence of cancer of the liver
Alcohol, Physiology, and Pathophysiology
• Liver (cont.)– Alcohol-induced liver disease
• Degree of malnutrition correlates with liver complications
• Malnutrition is correlated with mortality• Obesity is a risk factor for alcoholic liver disease
– Alcoholic cirrhosis– Alcohol-induced liver injury
Alcohol, Physiology, and Pathophysiology
• Esophageal Cancer– Drinking alcohol is a risk factor
• Stomach– Alcohol use decreases the amount of alcohol
dehydrogenase– Gastritis is more common in heavy drinkers– Alcohol intake causes gastrointestinal bleeding
• Pancreas– Moderately increased risk of pancreatic cancer in
heavy drinkers
Alcohol, Physiology, and Pathophysiology
• Heart– Cardiomyopathy may occur with chronic alcohol
abuse– Genetics plays a role– Older adults are at particular risk
• Musculoskeletal– Chronic alcohol may cause development of
myopathy• More frequent falls and fractures
Alcohol, Physiology, and Pathophysiology
• Immune System– Alcohol abusers are often immunocompromised
• More infections• Poorer outcomes
• Cancers– Excessive alcohol intake linked to several cancers
• Sleep– Quality of sleep is fragmented
Drug and Alcohol Interactions
• Alcohol interacts with many over-the-counter drugs and medications
• Alcohol increases the potential hepatotoxicity of certain drugs
• Alcohol combined with diuretics may cause hypokalemic myopathy
Screening for Alcohol Dependence• CAGE screening tool
– Cut down, Annoyed, Guilty, Eye-opener– Identifies 60% to 70% of those who are alcohol
dependent• Alcohol Use Disorders Identification Test
– More indicative of problem drinking than the CAGE
• Michigan Alcoholism Screening Test• National Institute on Alcohol Abuse and
Alcoholism
Positive Effects of Alcoholin Older Adults
• Stimulates appetite• Improves digestion and promotes relaxation
Positive Effects of Alcoholin Older Adults
• Bone Mineral Density– Moderate alcohol intake in older women
associated with higher BMD
• Cardiovascular Benefits– Association of alcohol intake and decreased
cardiovascular problems in men– Alcohol consumption has an inverse correlation
with renal dysfunction
Positive Effects of Alcoholin Older Adults
• Dementia– European studies demonstrate lower risk of
dementia with moderate alcohol intake– Increasing evidence shows that moderate intake
of alcohol improves cognitive function, psychological well-being, and improved quality of life of elderly people
Positive Effects of Alcoholin Older Adults
• Recommendations– Whether to
consume alcohol for medical purposes is a balancing act
– Similar benefits can accrue from exercise and a healthier diet
© Gualberto Becerra/ShutterStock, Inc.
Management of Alcohol Dependence
• Vitamins– 400 mg folic acid and/or a
multivitamin/multimineral supplement every day– Alcohol blocks absorption of folic acid– Alcohol lowers body’s magnesium levels
Management of Alcohol Dependence
• Medications– Not as effective in older adults as compared to
younger and middle-aged adults– Acamprosate
• Stabilizes the glutamate system in the brain– Topiramate
• Reduces dependence on the “rewarding” effects of alcohol
Management of Alcohol Dependence
• Nonpharmacologic Interventions: Therapy and Education– Older adults tend to respond well to treatment– Behavioral therapy
• Cognitive-behavioral therapy• Group and family therapy• Self-help group
– Alcoholics Anonymous• Model of helpful, positive partnering
– Teach use of healthy coping strategies
Conclusion
• The prevention of alcoholism begins with early teaching of the dangers of alcohol abuse, early recognition of risk factors for alcohol abuse, and early interventions
• Alcoholism can lead to social, functional, economic, psychological, and physiological consequences.