2017-09-14 13:43:02
 The New Old Age: Alcohol Abuse Is Rising Among Older Adults

In the summer, Henry Wrenn-Meleck likes to sit on the stoop of his building on the Upper West Side of Manhattan, observing the passing urban parade.

One day in late July, “one of my neighbors could see something was wrong,” he recently recalled. “I was sort of rolling around, obviously in a lot of pain. He said, ‘I have to call 911,’ and he did.”

Mr. Wrenn-Meleck, 63, an independent music publisher and dealer in rare guitars, spent three weeks in a hospital, being treated for trauma from a fall he does not recall. But the underlying problem was “40 years of being a very serious alcoholic,” he said. “My body finally said no more.”

Discharged from the hospital after detoxing, Mr. Wrenn-Meleck went to the New Jewish Home in Manhattan for physical therapy. He also entered its geriatric substance abuse recovery program where, he found, he was one of the younger participants.

Epidemiologists at the National Institute on Alcohol Abuse and Alcoholism last month reported a jarring trend: Problem drinking is rising fast among older Americans.

Their study, published in JAMA Psychiatry, compared data from a national survey taken in 2001 and 2002 and again in 2012 and 2013, each time with about 40,000 adults. Drinking had increased in every age group, the researchers found.

Those over 65 remained far less likely to drink than younger people — about 55 percent of older participants told interviewers they’d imbibed in the past year. Still, that was a 22 percent increase over the two periods, the greatest rise in any age group.

More troublingly, the proportion of older adults engaged in “high-risk drinking” jumped 65 percent, to 3.8 percent. The researchers’ definition: for a man, downing five or more standard drinks in a day (each containing 14 grams of alcohol) at least weekly during the past year; for a woman, four such drinks in a day.

And “alcohol use disorders” (we used to call it alcoholism), as defined in the psychiatric Diagnostic and Statistical Manual, more than doubled in a decade, afflicting over 3 percent of older people.

“The trajectory over time is remarkable,” said Dr. Marc Schuckit, a psychiatrist and addiction specialist at the University of California, San Diego, who wrote an editorial accompanying the new report. “You have to say there’s something going on.”

Even if the rate of alcohol problems among older people doesn’t climb further, the sheer numbers will increase. “The growth in that population portends problems down the road,” said Bridget Grant, an epidemiologist at N.I.A.A.A. and lead author of the study.

Why this spike in late-life drinking? Dr. Grant’s team didn’t investigate causes, but she speculates that anxiety caused by the recession, which hit right between the two surveys, may have played a part.

Other experts point to demographic differences. People in their 60s and early 70s are less frail than in previous generations — so they continue their drinking patterns. Moreover, the boomers have been more exposed to, and are less disapproving of, drug and alcohol use.

“It’s a lot more acceptable,” said Dr. David Oslin, a psychiatrist specializing in addiction at the University of Pennsylvania. “We no longer have those folks who grew up with Prohibition, with abstinence as a value.”

Even if older people are healthier, though, they’re still prone to late-life physical changes that make drinking riskier. Two drinks a night at age 40: maybe not an issue. Two daily drinks at 70: more complicated.

With each drink, an older person’s blood alcohol levels will rise higher than a younger drinker’s, Dr. Schuckit noted; older people have less muscle mass, and the liver metabolizes alcohol more slowly. Aging brains grow more sensitive to its sedative properties, too.

“It has a greater effect,” he said. “If I drink now the same way I did at 40, I’d better be careful.”

Most older people also have acquired common chronic diseases exacerbated by alcohol, like hypertension, diabetes and heart disease. Alcohol also is associated with a higher risk of stroke and several kinds of cancer.

And alcohol can play havoc with the medications people take to control those conditions. “Read your drug labels,” Dr. Oslin said. “Alcohol interferes or interacts with literally hundreds of prescription medications.”

He has grown accustomed to enlightening patients who think they can safely drink wine at dinner because they don’t take their pills until the next morning. “That medication is in your system 24/7,” he said. Drinking can render it less effective, or even dangerous.

We may already be seeing the health consequences, Dr. Grant pointed out. The nation’s sharp decline in cardiovascular disease and strokes has begun to level off. Emergency room visits for alcohol-related falls, particularly disabling for seniors, have increased.

So have deaths from liver cirrhosis. “It’s the first time we’ve seen those rates go up since the 1960s,” Dr. Grant said. “It’s shocking.”

She advocates a national educational campaign to alert older people to the dangers of excessive drinking — and for some, any drinking.

Primary care doctors also need to pay attention, Dr. Oslin said. Though the U.S. Preventive Services Task Force has recommended screening all adults for alcohol misuse, “I don’t know how many do.”

Alcohol abuse remains undertreated in all age groups. Part of the mythology of late-life drinking is that old people can’t or won’t change their longtime behavior.

Sometimes, that’s true. Caryn Isaacs, a longtime private patient advocate working in New York City and on Long Island, told me harrowing stories about older clients who abused alcohol and resisted repeated efforts to help them stop.

A 62-year-old faced eviction from a reeking apartment after months of not paying rent or cleaning up after several cats. A 78-year-old, over a few years, sent $300,000 from her pension account to a telephone scammer who told her he loved her.

A 68-year-old in a wheelchair got bounced from several assisted living facilities for violent, belligerent behavior while drinking and is held now in a locked ward at a Queens nursing home while a court considers guardianship.

But with treatment, older adults have the same or better success rates as younger drinkers. In a study by Dr. Oslin and colleagues, seniors were far more likely to adhere to treatment. Although 40 percent relapsed during the 12-week trial, nearly two-thirds of younger patients did.

“The problem is getting them into treatment,” Dr. Oslin said of older patients.

At the New Jewish Home, which three years ago became the first nursing home to integrate addiction treatment into post-hospital rehab, the average age of patients in the substance abuse program is 65, but many are older.

Yet 69 percent of those addicted to alcohol reported no relapse a month after their discharge, the home reported last year; about half say they’ve continued with therapy or attend Alcoholics Anonymous meetings.

Mr. Wrenn-Meleck spent 12 days in the program, rebuilding his physical strength and attending individual and group therapy sessions; he now plans to begin outpatient therapy.

“I’m feeling good,” he said, a nondrinker for the first time in decades. “I don’t want to worry about it anymore.”