alcohol use in older adults - chapter 15
DESCRIPTION
“The French Paradox” Benefits of red wine Contain substances that appear to prevent blood clots Prevents oxidation of low-density lipoproteins Raises high-density lipoproteins Alcohol Good for the heart and circulatory system Protective against diabetes and gallstonesTRANSCRIPT
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Alcohol Use in Older Adults
Chapter 15
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Introduction
• “The French Paradox”– Benefits of red wine
• Contain substances that appear to prevent blood clots
• Prevents oxidation of low-density lipoproteins• Raises high-density lipoproteins
• Alcohol– Good for the heart and circulatory system– Protective against diabetes and gallstones
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Introduction
• Heavy drinking– Major cause of preventable death
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Alcohol and Alcohol Use Defined
• “Moderate” amount– When health benefits outweigh the risks– 1-2 drinks/day for men– 1 drink/day for women
• As a nutrient– Provides 7 Kcal/gram– A food, but not a nutrient– Not stored in body– Acts like a drug
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Epidemiology
• Age• Geographic differences• Various alcohol related diseases causing death• Drinking patterns in older adults• Gender
– Men are two times more likely than women to drink excessively
– Women are more vulnerable to the consequences of alcohol use
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Epidemiology
• Alcoholism Theories– Biogenetic model – Sociocultural model– Learning theory/behavior model– Psychological-psychodynamic model
• Genetics– First-degree relatives’ share genetic risk factors
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Age-Related ChangesAffecting Alcohol Intake
• Physical changes– Body water to fat ratio decreases– Hepatic blood flow decreases– Liver enzymes diminish in efficiency– Increased permeability of blood-brain barrier
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Nutritional Intake
• Alcohol adds calories without nutritional benefits
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Risk Factors
• Age related problems and chronic health problems
• Physical changes– Less tolerant of alcohol
• Risks and benefits of alcohol consumption with aging
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Alcohol, Physiology, and Pathophysiology
• Absorption begins in mouth and esophagus• Primary site of absorption is the small
intestine
Insel P, Turner RE, Ross D. Nutrition. 3rd ed. Sudbury, MA: Jones & Bartlett; 2007, p. 306. Reproduced with permission.
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Alcohol, Physiology, and Pathophysiology
• Food delays rate of alcohol absorption• Alcohol metabolism occurs in liver
– Quick metabolism– Fatty liver
• Alcohol has a more serious damaging effect in women compared to men
• Alcohol stimulates appetite
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Alcohol, Physiology, and Pathophysiology
• The Brain and Nervous System– Memory impairments can result– Facilitates dopamine transmission– Causes changes in brain’s normal activity– Decline in cognitive and physical function– Hepatic encephalopathy (brain disease)
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Alcohol, Physiology, and Pathophysiology
• Vitamin and Nutrient Deficiencies– Decreases absorption of vitamins and minerals
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Alcohol, Physiology, and Pathophysiology
• Vitamin and Nutrient Deficiencies
Alcohol and Malnutrition
Insel P, Turner RE, Ross D. Nutrition. 3rd ed. Sudbury, MA: Jones & Bartlett;2007, p. 319. Reproduced with permission.
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Alcohol, Physiology, and Pathophysiology
• Vitamin and Nutrient Deficiencies– Thiamine
• Result = impairment of the brain and neurological system
• Risk of Wenicke-Korsakoff syndrome– Folic acid
• Alcohol blocks absorption of folic acid• Chronic alcohol abuse may result in
macrocytosis
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Alcohol, Physiology, and Pathophysiology
• Vitamin and Nutrient Deficiencies (cont.)– Hormones
• Drinking one drink per day increases risk for breast cancer up to age 70
• Liver– Alcoholic liver disease
• Fatty liver• Alcoholic hepatitis• Cirrhosis
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Alcohol, Physiology, and Pathophysiology
• Liver– Alcoholic liver disease
• Fatty liver• Alcoholic hepatitis• Cirrhosis
–Scarring of the liver–Potentially fatal– Increases the incidence of cancer of the liver
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Alcohol, Physiology, and Pathophysiology
• Liver (cont.)– Alcohol-induced liver disease
• Degree of malnutrition correlates with liver complications
• Malnutrition is correlated with mortality• Obesity is a risk factor for alcoholic liver disease
– Alcoholic cirrhosis– Alcohol-induced liver injury
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Alcohol, Physiology, and Pathophysiology
• Esophageal Cancer– Drinking alcohol is a risk factor
• Stomach– Alcohol use decreases the amount of alcohol
dehydrogenase– Gastritis is more common in heavy drinkers– Alcohol intake causes gastrointestinal bleeding
• Pancreas– Moderately increased risk of pancreatic cancer in
heavy drinkers
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Alcohol, Physiology, and Pathophysiology
• Heart– Cardiomyopathy may occur with chronic alcohol
abuse– Genetics plays a role– Older adults are at particular risk
• Musculoskeletal– Chronic alcohol may cause development of
myopathy• More frequent falls and fractures
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Alcohol, Physiology, and Pathophysiology
• Immune System– Alcohol abusers are often immunocompromised
• More infections• Poorer outcomes
• Cancers– Excessive alcohol intake linked to several cancers
• Sleep– Quality of sleep is fragmented
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Drug and Alcohol Interactions
• Alcohol interacts with many over-the-counter drugs and medications
• Alcohol increases the potential hepatotoxicity of certain drugs
• Alcohol combined with diuretics may cause hypokalemic myopathy
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Screening for Alcohol Dependence• CAGE screening tool
– Cut down, Annoyed, Guilty, Eye-opener– Identifies 60% to 70% of those who are alcohol
dependent• Alcohol Use Disorders Identification Test
– More indicative of problem drinking than the CAGE
• Michigan Alcoholism Screening Test• National Institute on Alcohol Abuse and
Alcoholism
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Positive Effects of Alcoholin Older Adults
• Stimulates appetite• Improves digestion and promotes relaxation
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Positive Effects of Alcoholin Older Adults
• Bone Mineral Density– Moderate alcohol intake in older women
associated with higher BMD
• Cardiovascular Benefits– Association of alcohol intake and decreased
cardiovascular problems in men– Alcohol consumption has an inverse correlation
with renal dysfunction
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Positive Effects of Alcoholin Older Adults
• Dementia– European studies demonstrate lower risk of
dementia with moderate alcohol intake– Increasing evidence shows that moderate intake
of alcohol improves cognitive function, psychological well-being, and improved quality of life of elderly people
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Positive Effects of Alcoholin Older Adults
• Recommendations– Whether to
consume alcohol for medical purposes is a balancing act
– Similar benefits can accrue from exercise and a healthier diet
© Gualberto Becerra/ShutterStock, Inc.
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Management of Alcohol Dependence
• Vitamins– 400 mg folic acid and/or a
multivitamin/multimineral supplement every day– Alcohol blocks absorption of folic acid– Alcohol lowers body’s magnesium levels
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Management of Alcohol Dependence
• Medications– Not as effective in older adults as compared to
younger and middle-aged adults– Acamprosate
• Stabilizes the glutamate system in the brain– Topiramate
• Reduces dependence on the “rewarding” effects of alcohol
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Management of Alcohol Dependence
• Nonpharmacologic Interventions: Therapy and Education– Older adults tend to respond well to treatment– Behavioral therapy
• Cognitive-behavioral therapy• Group and family therapy• Self-help group
– Alcoholics Anonymous• Model of helpful, positive partnering
– Teach use of healthy coping strategies
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Conclusion
• The prevention of alcoholism begins with early teaching of the dangers of alcohol abuse, early recognition of risk factors for alcohol abuse, and early interventions
• Alcoholism can lead to social, functional, economic, psychological, and physiological consequences.