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Why do older Americans drink so much?

The phone woke Doug Nordman at 3 a.m. A surgeon was calling from a hospital in Grand Junction, Colo., where Mr. Nordman’s father had arrived in the emergency room, incoherent and in pain, then lost consciousness.

Staff initially thought he was suffering a heart attack, but a scan revealed part of his small intestine had been perforated. A surgical team repaired the hole, saving his life, but the surgeon had some questions.

“Was your father an alcoholic?” He asked. Doctors found Dean Nordman malnourished, his peritoneal cavity “flooded with alcohol.”

The younger Mr. Nordman, a military author on personal finance living on Oahu, Hawaii, said his father, 77, had long been a classic social drinker: a scotch and water with his wife before dinner, which was completed during dinner. , then another after dinner, and maybe a nightcap.

Drinking three to four drinks per day exceeds current dietary guidelines, which define moderate drinking as two drinks per day for men and one for women, or less. But “that was the normal drinking culture at the time,” said Doug Nordman, now 63.

At the time of his hospitalization, Dean Nordman, a retired electrical engineer, was widowed, living alone and developing symptoms of dementia. He got lost while driving, struggled to do household chores, and complained of a “slippery memory.”

He had rejected offers of help from his two sons, saying he was fine. However, during this hospitalization, Doug Nordman found virtually no food in his father’s apartment. Worse still, while reviewing his father’s credit card statements, “I saw recurring bills from the Liquor Barn and realized he was drinking a pint of scotch a day,” he said .

Public health officials are increasingly alarmed by older Americans’ drinking. The annual number of alcohol-related deaths between 2020 and 2021 exceeded 178,000, according to data recently released by the Centers for Disease Control and Prevention: more deaths than those from all drug overdoses combined.

An analysis by the National Institute on Alcohol Abuse and Alcoholism shows that people over 65 made up 38 percent of that total. From 1999 to 2020, the 237% increase in alcohol-related deaths among those over 55 was higher than in any age group except 25 to 34 year olds.

Most Americans don’t recognize the dangers of alcohol, said George Koob, director of the institute. “Alcohol is a social lubricant when used within guidelines, but I don’t think they realize that as the dose increases it becomes a toxin,” he said. “And the older population is even less likely to recognize it.” »

The growing number of elderly people largely explains the increase in deaths, Dr. Koob said. An aging population portends a continued increase that worries health care providers and advocates for older adults, even if older adults’ drinking behavior does not change.

But that has changed. The proportions of people over 65 reporting drinking in the past year (around 56 percent) and last month (around 43 percent) are lower than all other age groups. adults. But older drinkers are significantly more likely to do so frequently, 20 or more days per month, than younger drinkers.

Additionally, a 2018 meta-analysis found that binge drinking (defined as four or more drinks on one occasion for women, five or more for men) had increased by nearly 40% among Americans older over the past 10 to 15 years.

What is happening here?

The pandemic clearly played a role. The CDC reported that deaths directly attributable to alcohol consumption, alcohol-associated emergency room visits, and per capita alcohol sales all increased from 2019 to 2020, as Covid arrived and restrictions were imposed.

“There were a lot of stressors that affected us: the isolation, the fear of getting sick,” Dr. Koob said. “They point out that people are drinking more to cope with this stress.”

The researchers also mention a cohort effect. Compared to those before and after them, “baby boomers are a substance-using generation,” said Keith Humphreys, a psychologist and addiction researcher at Stanford. And they’re not abandoning their youthful behavior, he said.

Studies also show a narrowing of the gender divide. “Women have been the drivers of change in this age group,” Dr Humphreys said.

From 1997 to 2014, alcohol consumption increased by an average of 0.7% per year among men over 60, while their binge drinking remained stable. Among older women, alcohol consumption increased by 1.6 percent per year, with binge drinking increasing by 3.7 percent.

“Contrary to stereotypes, educated, upper-middle-class people have higher rates of alcohol consumption,” Dr. Humphreys explained. In recent decades, as women became more educated, they entered workplaces where alcohol consumption was normative; they also had higher disposable income. “Women retiring today are more likely to drink than their mothers and grandmothers,” he said.

Yet alcohol consumption is more harmful to older people, especially women, who get drunk more quickly than men because they are smaller and have fewer intestinal enzymes that metabolize alcohol.

Older people may claim they’re just drinking like they always have, but “equivalent amounts of alcohol have far more dire consequences for older people,” whose bodies can’t process it as quickly, a said Dr. David Oslin, a psychiatrist at the University of Pennsylvania and the Veterans Affairs Medical Center in Philadelphia.

“This leads to slower thinking, slower reaction time and decreased cognitive abilities when you are older,” he said, listing the risks.

Long associated with liver disease, alcohol also “exacerbates cardiovascular and kidney disease, and if you’ve been drinking for many years, there’s an increase in certain types of cancer,” he said. Alcohol consumption contributes to falls, a leading cause of injuries as people age, and disrupts sleep.

Older adults also take a lot of prescription medications, and alcohol interacts with a long list of them. These interactions can be especially common with painkillers and sleeping pills like benzodiazepines, sometimes causing excessive sedation. In other cases, alcohol can reduce the effectiveness of a medication.

Dr. Oslin cautions that although many prescription bottles have labels warning against using these drugs with alcohol, patients may ignore this, explaining that they take their pills in the morning and do not only drink in the evening.

“These drugs are in your body all day long, so when you drink, there’s always that interaction,” he tells them.

One proposal to combat alcohol abuse among seniors is to raise the federal tax on alcohol, for the first time in decades. “Alcohol consumption is price sensitive, and it is currently quite cheap relative to income,” Dr. Humphreys said.

Resisting industry lobbying and making alcohol more expensive, the same way higher taxes made cigarettes more expensive, could reduce consumption.

The same goes for removing barriers to treatment. Treatments for excessive drinking, including psychotherapy and medication, are no less effective for older patients, Dr. Oslin said. In fact, “age is actually the best indicator of a positive response,” he said, adding that “treatment doesn’t necessarily mean you have to become abstinent.” We work with people to moderate their alcohol consumption.

But the 2008 federal law requiring health insurers to offer parity – that is, the same coverage for mental health, including substance use disorders, as for other medical conditions – does not does not apply to Medicare. Several political and advocacy groups are working to eliminate these disparities.

Dean Nordman never sought treatment for his drinking, but after his emergency surgery, his sons moved him to a nursing home, where antidepressants and lack of access to alcohol improved his mood and sociability. He died in the facility’s memory care unit in 2017.

Doug, whose father introduced him to beer when he was 13, was himself a heavy drinker, he says, “to the point of blacking out” when he was a student, and a social drinker afterward. .

But as he watched his father decline, “I realized it was ridiculous,” he recalls. Alcohol can exacerbate the progression of cognitive decline and there was a family history of it.

He has remained sober since that pre-dawn phone call 13 years ago.

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