The phone woke Doug Nordman at 3 in the morning. A surgeon was calling from a hospital in Grand Junction, Colo., where Mr. Nordman’s father had arrived at the emergency room, incoherent and in pain, then passed out.
At first, staff thought he had suffered a heart attack, but a CT scan found 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?” asked. Doctors found Dean Nordman malnourished, his peritoneal cavity “flooded with alcohol.”
The younger Mr. Nordman, a military personal finance writer who lives on Oahu, Hawaii, explained that his 77-year-old dad had long been a classic drinker: a scotch and water with his wife before dinner, which was eaten during dinner. , then another after dinner, and maybe an evening drink.
Drinking three to four drinks a day exceeds current dietary guidelines, which define moderate consumption as two drinks a day for men and one for women, or less. But “that was the normal drinking culture of the time,” said Doug Nordman, now 63.
However, at the time of his hospitalization, Dean Nordman, a retired electrical engineer, was widowed, living alone and showing symptoms of dementia. He got lost while driving, struggled with household chores, and complained of a “slipped memory.”
He had dismissed his two sons’ offers of help, saying they were fine. During this hospitalization, however, Doug Nordman found almost no food in his father’s apartment. Worse, looking at his father’s credit card statements, “I saw recurring charges from the Liquor Barn and realized he was drinking a pint of scotch a day,” he said.
Public health officials are increasingly concerned about the drinking of older Americans. The annual number of alcohol-related deaths from 2020 to 2021 topped 178,000, according to newly released data from the Centers for Disease Control and Prevention: more deaths than from drug overdoses combined.
An analysis by the National Institute on Alcohol Abuse and Alcoholism shows that people over 65 accounted for 38 percent of that total. From 1999 to 2020, the 237 percent increase in alcohol-related deaths among people over 55 was higher than for any age group except 25 to 34-year-olds.
Americans largely fail to recognize the dangers of alcohol, said George Koob, director of the institute. “Alcohol is a social lubricant when used as directed, 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 that.”
The growing number of elderly people is responsible for much of the increase in deaths, Dr. Koob said. The aging population portends a continued increase that has health care providers and senior advocates worried, even if seniors’ drinking behavior does not change.
But it has changed. The percentages of people over 65 who report drinking in the past year (about 56 percent) and in the past month (about 43 percent) are lower than for all other adult groups. But older drinkers are much more likely to do so frequently, 20 or more days a month, than younger drinkers.
Additionally, a 2018 meta-analysis found that binge drinking (defined as four or more drinks on a single occasion for women, five or more for men) had increased by nearly 40% among older Americans over the past 10 up to 15 years.
What is happening here?
The pandemic has clearly played a role. The CDC reported that deaths directly attributable to alcohol use, alcohol-related emergency room visits and per capita alcohol sales increased from 2019 to 2020 as Covid arrived and restrictions were imposed.
“Many stressors affected us: isolation, worries about getting sick,” Dr. Koob said. “They point to people drinking more to cope with that stress.”
The researchers also report a cohort effect. Compared to those before and after them, “boomers are a substance-using generation,” said Keith Humphreys, a psychologist and addiction researcher at Stanford. And they don’t give up their youthful behavior, he said.
Studies also show a narrow gender gap. “Women have been the drivers of change in this age group,” Dr Humphreys said.
From 1997 to 2014, drinking increased an average of 0.7 percent per year for men over 60, while binge drinking remained stable. Among older women, alcohol consumption rose 1.6 percent annually, with binge drinking up 3.7 percent.
“Contrary to stereotypes, upper-middle-class, educated people have higher rates of alcohol consumption,” Dr Humphreys explained. In recent decades, as women became more educated, they entered workplaces where drinking was normative. they also had more disposable income. “Women who are now retired are more likely to drink than their mothers and grandmothers,” he said.
However, alcohol use has a greater burden on the elderly, especially women, who get drunk faster than men because they are smaller and have fewer gut enzymes that metabolize alcohol.
Older people may argue that they’re just drinking the way they always do, but “equal amounts of alcohol have far more damaging effects on older people, whose bodies can’t process it as quickly,” said Dr. David Oslin, a psychiatrist at University of Pennsylvania and the Veterans Affairs Medical Center in Philadelphia.
“It causes slower thinking, slower reaction time and less cognitive ability when you’re older,” he said, noting the risks.
Long associated with liver disease, alcohol also “exacerbates cardiovascular disease, kidney disease, and if you drink for many years, there’s an increase in certain types of cancer,” he said. Drinking contributes to falls, a leading cause of injury as people age, and disrupts sleep.
Seniors also take many prescription medications, and alcohol interacts with a long list of them. These interactions can be especially common with pain relievers and sleep aids such as benzodiazepines, sometimes causing excessive sedation. In other cases, alcohol can reduce the effectiveness of a drug.
Dr. Oslin cautions that while many prescription bottles carry labels warning about using these medications with alcohol, patients may avoid it, explaining that they take their pills in the morning and don’t drink until the evening.
“These drugs are in your system all day, so when you drink, there’s still that interaction,” he tells them.
One proposal to combat alcohol abuse among seniors is to raise the federal alcohol tax for the first time in decades. “Alcohol consumption is price sensitive and is quite cheap at the moment relative to income,” Dr Humphreys said.
Resistance from industry lobbies and rising alcohol prices, just as higher taxes have made cigarettes more expensive, could reduce use.
Thus, barriers to treatment can be eliminated. Treatments for excessive alcohol use, including psychotherapy and medication, are no less effective for older patients, Dr. Oslin said. In fact, “age is actually the best predictor of a positive response,” he said, adding that “treatment does not necessarily mean abstinence. We work with people to moderate their drinking.”
However, the 2008 federal law requiring health insurers to provide parity — that is, the same coverage for mental health, including substance use disorders, as for other medical conditions — does not apply to Medicare. Many policy and advocacy groups are working to eliminate such disparities.
Dean Nordman never sought treatment for his drinking, but after emergency surgery, his sons moved him into a nursing home, where antidepressants and a lack of access to alcohol improved his mood and sociability. He died in the facility’s memory care unit in 2017.
Doug, who was introduced to beer by his father when he was 13, was himself a heavy drinker, he said, “to the point of blacking out” as a college student and then drank socially.
But as he watched his father decline, “I realized this was ridiculous,” he recalls. Alcohol can worsen the progression of cognitive decline and he had a family history.
He has remained sober since that phone call 13 years ago.
