Alcohol Consumption and Health
The prevalence of alcohol consumption among adults aged 60 and older is increasing in the USA (Breslow et al. 2017). Alcohol misuse is linked to a wide range of medical conditions and injuries, but some controversial evidence has indicated that moderate alcohol consumption may be associated with reduced mortality. Here, we summarize current research on alcohol consumption and health and apply the findings to drinking guidelines for older adults.
Key Research Findings
Alcohol misuse is a risk factor for a wide range of medical conditions and injuries. Yet, some findings from observational studies have suggested that, compared to abstention, moderate alcohol consumption may be associated with reduced mortality (See “Experimental Studies and Observational Studies”) Moderate consumption is generally defined as an average of 1–2 drinks a day. Findings commonly fit a J-shaped curve. Compared to abstention (the left side of the curve), mortality is lower at moderate consumption; compared to high consumption (the right side of the curve), mortality is markedly lower at moderate consumption. However, these findings are controversial due to some serious methodological concerns.
A key area of controversy involves the reasons why moderate drinkers tend to have lower mortality than abstainers. One issue is that abstainers may be of lower socioeconomic status and be in poorer health than moderate drinkers, and that these differences are not fully adjusted for in some studies (See “Selective Bias in Longitudinal Studies”). In addition, current abstainers may include individuals who were heavy or problem drinkers in the past and quit drinking after becoming ill. For example, a recent meta-analysis (Stockwell et al. 2016) concluded that studies with appropriate statistical controls that use lifetime, rather than current, abstainers do not show a significant longevity advantage associated with moderate alcohol consumption.
Another issue involves the need to specify the medical conditions underlying the association between alcohol consumption and mortality. Potential positive health outcomes associated with moderate alcohol consumption are limited primarily to coronary heart disease (See “Ischemic Heart Disease”). Observational studies of broad samples across the adult lifespan support a J-shaped association between alcohol consumption and coronary heart disease morbidity and mortality (Roerecke and Rehm 2014). Possible mechanisms include the role of alcohol in improving the profile of good vs. bad cholesterol, reducing fibrinogen levels and platelet reactivity in the blood, and controlling inflammation. These mechanisms appear to be associated with alcohol in general rather than with any specific beverage type.
However, average alcohol consumption above 1–2 drinks per day increases the risk of health problems and injury. Even in the case of cardiovascular disease, consumption above 1–2 drinks per day is linked to increased risk for hypertension, arrhythmias, stroke, and alcoholic cardiomyopathy. Moreover, any potential reduction in heart disease associated with moderate alcohol consumption is offset by an increase in cancer risk (Kunzmann et al. 2018) (See “Epidemiology, Aging, and Cancer”). There is a linear association between average lifetime alcohol consumption and increasing cancer risk, including cancers of the oral cavity, throat, esophagus, breast, colorectum, and liver.
Another area of concern is the pattern of alcohol consumption. Analyses of moderate drinking have focused on average consumption, which masks diverse drinking patterns. Among individuals whose average consumption is moderate, drinking may vary from a regular pattern of consumption to one that includes episodic heavy (binge) drinking. Episodic heavy drinking erases any potential positive health outcomes associated with moderate average alcohol consumption (Holahan et al. 2015; Roerecke and Rehm 2014). More generally, episodes of heavy drinking concentrate alcohol’s toxicity and substantially increase the risk of health problems and accidents.
Application: Drinking Guidelines for Older Adults
Older adults are particularly vulnerable to alcohol beyond alcohol’s general health risks. Among older adults, alcohol can worsen existing health problems, provoke falls and unintentional injuries, and interact adversely with medications (Han et al. 2017). For adults over age 65 who consume alcohol, the US National Institute on Alcohol Abuse and Alcoholism (NIAAA 2016) recommends no more than seven drinks per week and no more than three drinks on any day. However, research examining drinking problems among older adults up to age 75–85 supports more conservative daily drinking guidelines of no more than two drinks on any day (Moos et al. 2009). In the context of drinking guidelines, the NIAAA defines a standard drink as one beer (12 oz.), one glass of wine (5 oz.), or one shot of distilled spirits (1.5 oz.). The NIAAA also recommends that older adults who have a history of alcohol problems, who have medical conditions alcohol can aggravate, or who take medications that interact with alcohol should drink less than general guidelines or not at all. For nondrinkers, beginning to drink for health reasons is not advised (Roerecke and Rehm 2014).
Although there is some evidence that moderate alcohol consumption may be associated with reduced mortality, particularly coronary heart disease mortality, the findings are controversial. Moreover, average alcohol consumption above 1–2 drinks per day increases the risk of accidents and health problems, including cardiovascular disease, and alcohol consumption is linearly related to increasing cancer risk. A pattern of episodic heavy drinking substantially increases risk of health problems and accidents. Older adults are particularly vulnerable to alcohol, which can worsen medical conditions, provoke unintentional injuries, and interact adversely with medications.
- NIAAA (2016) Rethinking drinking: alcohol and your health. NIH Publication No. 15-3770Google Scholar
- Roerecke M, Rehm J (2014) Alcohol consumption, drinking patterns, and ischemic heart disease: a narrative review of meta-analyses and a systematic review and meta-analysis of the impact of heavy drinking occasions on risk for moderate drinkers. BMC Med 12:182. https://doi.org/10.1186/s12916-014-0182-6CrossRefGoogle Scholar