Annals of Long Term Care

AGS CLINICAL PRACTICE GUIDELINES

SCREENING RECOMMENDATION
All patients 65 or older should be asked about their use of alcohol at least annually to identify possible alcohol use disorders.

RATIONALE
About half of the population aged > 65 drinks alcohol; up to 15% may be experiencing health risks from either the amount of alcohol they consume alone or the combination of alcohol use with medications and chronic diseases; 2-4% may have abuse or dependence (“alcoholism”).

Age-Related Physiological Changes that Affect Risks Associated with Alcohol
Older adults have higher blood alcohol levels per amount consumed than do younger adults, due to decreased gastric alcohol dehydrogenase and lower volume of distribution.

Aging may increase sensitivity to alcohol, particularly in the central nervous system.

Medications that May Interact Adversely with Alcohol
90% of older adults use medications, and as many as 100% may interact adversely with alcohol. Alcohol combined with:

• H2 blockers, aspirin may raise alcohol levels.
• benzodiazepines, tricyclic antidepressants, narcotics, barbiturates, antihistamines may increase sedation and impair psychomotor function.
• aspirin, NSAIDs may increase bleeding time and cause gastric inflammation and bleeding.
• metronidazole, sulfonamides, longer-acting oral hypoglycemics (tolbutamide, chlorpropamide) may cause disulfiram-like response, with nausea/vomiting.
• reserpine, aldomet, nitroglycerine, hydralazine may produce hypotension.
• acetaminophen, isoniazid, phenylbutazone may increase hepatotoxicity.
• antihypertensives, antidiabetic drugs, drugs for ulcers, gout, and heart failure may exacerbate the underlying disease.
• benzodiazepines, narcotics, barbiturates, warfarin, propranolol, isoniazid, and tolbutamide may alter drug metabolism.

Chronic Conditions that May Be Triggered or Worsened by Alcohol Use
30% of older adults who drink alcohol may trigger or worsen chronic conditions including:

• Cirrhosis and other liver conditions, gastrointestinal bleeding, ulcers or gastroesophageal reflux disease
• Gout, hypertension or diabetes
• Insomnia, gait disorders
• Depression, anxiety or other mental conditions

SPECIAL ATTENTION TO THE PATIENT WHO USES MORE THAN ONE SUBSTANCE
Be aware of use of other potentially addictive substances in addition to alcohol (prescription drugs like sedatives or narcotic analgesics, illicit drugs, nicotine); they may interact/reinforce each other.