Doug Nordman was woken up by a phone call at 3 a.m. A surgeon called from a hospital in Grand Junction, Colorado. Nordman's father arrived at the emergency room unable to communicate and in pain, before losing consciousness.
Staff initially thought he was having a heart attack, but a CT scan revealed a hole in part of his small intestine. A team of surgeons repaired the hole and saved his life, but the surgeons had some questions.
“Was your father an alcoholic?” he asked. Doctors found Nordmandine was malnourished and his abdominal cavity was “filled with alcohol.”
The younger Nordman, an author of Military Personal Finance who lives on the Hawaiian island of Oahu, explained that his 77-year-old father had always been a classic social drinker. That is, he drank scotch and water with his wife before dinner and refilled it during dinner. , another drink after dinner, and perhaps a nightcap.
Drinking three to four drinks a day exceeds current dietary guidelines, which define moderate intake as two drinks a day for men and no more than one drink a day for women. But “that was the normal drinking culture at the time,” says Doug Nordman, now 63.
However, at the time of hospitalization, Dean Nordman, a retired electrician, was living alone, a widow, and was showing symptoms of dementia. He got lost while driving, struggled with household chores, and complained that his “memory was flying.”
He declined offers of help from his two sons, saying he was fine. But during his hospitalization, Doug Nordman found little food in his father's apartment. To make matters worse, when he checked his father's credit card statement, “I saw a recurring charge from the liquor store and noticed that his father was drinking a pint of Scotch a day.” He said.
Public health officials are increasingly concerned about alcohol consumption among older Americans. According to recently released data from the U.S. Centers for Disease Control and Prevention, there will be more than 178,000 annual alcohol-related deaths from 2020 to 2021, more than all drug overdose deaths combined.
According to an analysis by the National Institute on Alcohol Abuse and Alcoholism, people over 65 years old account for 38% of the total. From 1999 to 2020, the 237 percent increase in alcohol-related deaths among people 55 and older was higher than any other age group except those 25 to 34.
George Korb, the institute's director, said Americans are largely unaware of the dangers of alcohol. “I don't think they understand that alcohol is a social lubricant when used within guidelines, but in higher doses it becomes a toxin,” he says. “And older people are even less likely to recognize it.”
Dr Korb said the increase in the number of elderly people was a major cause of the increase in deaths. Even if older people's drinking behavior does not change, the aging population portends continued growth, worrying health care providers and advocates for the elderly.
However, things are changing. The proportion of people 65 and older who reported using alcohol in the past year (about 56 percent) and in the past month (about 43 percent) is lower than all other adult groups. However, older drinkers are significantly more likely than younger people to drink frequently on more than 20 days per month.
Additionally, a 2018 meta-analysis found that binge drinking (defined as 4 or more drinks at one time for women and 5 or more for men) has increased by nearly 40% among older Americans over the past 10 to 15 years. It turned out that there was.
what's happening?
The pandemic clearly plays a role. According to a CDC report, the arrival of the novel coronavirus and the establishment of regulations have led to an increase in the number of deaths directly attributable to alcohol use, the number of alcohol-related emergency department visits, and the amount of alcohol sold per capita from 2019 to 2020. all increased.
“Many stressors affected us, including loneliness and worries about illness,” Dr. Korb said. “They point out that people are drinking more to cope with that stress.”
The researchers also mentioned cohort effects. Keith Humphreys, a psychologist and addiction researcher at Stanford University, said that compared to the generations before and after them, “boomers are the drug-using generation.” And they haven't abandoned their youthful behavior, he said.
Research also shows that the gap between men and women is narrowing. “Women are the driving force behind change in this age group,” Dr. Humphries said.
From 1997 to 2014, the amount of alcohol consumed by men over 60 increased by an average of 0.7% per year, but their heavy drinking remained stable. Alcohol consumption among older women increased by 1.6% annually, and binge drinking increased by 3.7%.
“Contrary to stereotypes, people with upper-middle class education have higher rates of drinking,” Dr. Humphries explained. In recent decades, as women have become more educated, they have entered workplaces where drinking is the norm. They also had more disposable income. “Women who are currently retired are more likely to drink alcohol than their mothers and grandmothers,” he says.
However, alcohol consumption is more damaging to older people, especially women, because they are smaller and have fewer intestinal enzymes to metabolize alcohol, so they get drunk more quickly than men.
Older people may claim they're just drinking normally, but the University of Wisconsin says the same amount of alcohol has more dire consequences for older people because their bodies can't process alcohol quickly. says psychiatrist Dr. David Oslin. Veterans Affairs Medical Centers in Pennsylvania and Philadelphia;
“As we get older, we think more slowly, our reaction times slow down, and our cognitive abilities decline,” he said, pointing to the risks.
Alcohol, which has long been associated with liver disease, “exacerbates cardiovascular disease and kidney disease, and long-term drinking also increases certain types of cancer,” he says. Alcohol contributes to falls, a leading cause of age-related injuries, and disrupts sleep.
Older adults also take many prescription medications, and alcohol interacts with that long list. These interactions are especially common with painkillers and sleep aids such as benzodiazepines, which can cause excessive sedation in some cases. Alcohol may also make some medicines less effective.
Dr. Oslin said many prescription drug bottles have labels warning them not to be combined with alcohol, but patients may ignore them and explain that they take their medication in the morning and don't drink it until the evening. Warn that there is.
“These drugs are in your body all day long, so when you drink alcohol, they leave an interaction,” he tells them.
One proposal to combat alcohol abuse among seniors is to raise federal taxes on alcohol for the first time in decades. “Alcohol consumption is price-driven, which is currently quite low relative to income,” Dr Humphreys says.
In defiance of industry lobbying, higher prices for alcohol could reduce usage, just as tax hikes have made cigarettes more expensive.
It is also possible to remove barriers to treatment. Dr. Oslin said treatments for excessive alcohol consumption, such as psychotherapy and medication, are equally effective for older patients. In fact, “age is actually the best predictor of a positive response,” he said, adding that “treatment doesn't necessarily mean you need to be abstinent.” We work with people to moderate their drinking. ”
However, a 2008 federal law that requires health insurance companies to provide parity (meaning the same coverage for mental health conditions, including substance use disorders, as for other medical conditions) does not apply to Medicare. Several policy and advocacy groups are working to close such disparities.
Dean Nordmann did not seek treatment for his drinking, but after emergency surgery his sons moved him to a nursing home where he was given antidepressants and his mood and sociability improved as he was no longer able to consume alcohol. did. He died in the facility's memory care unit in 2017.
Doug was introduced to beer by his father when he was 13 years old, and said he himself was a heavy drinker “to the point of blackouts” in college, and later began drinking socially.
But as he watched his father refuse, he recalled, “I realized this is ridiculous.” Alcohol can worsen the progression of cognitive decline, and he had a family history of it.
He has remained sober since that pre-dawn phone call 13 years ago.