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How much is good?

RESTRAINT Keep temptation away

Is alcohol a tonic or a toxin? The question is especially critical to older people, whose overall medical picture gives alcohol the potential to be a health benefit or a life-shortening hazard.

Yet experts say that doctors rarely ask older patients how much and how often they drink. Not knowing the answers to these questions can result in misdiagnosis, medical complications and life-threatening accidents. Doctors may also fail to recognise the symptoms of alcohol abuse, a problem that is expected to become increasingly common as baby boomers, who have been found to drink more than previous generations, reach age 65 and beyond.

At the same time, older people who are in good health should know that moderate drinking under the right conditions may improve their health in several important ways. In a comprehensive review in the October issue of “The Journal of the American Dietetic Association”, Maria Pontes Ferreira and M.K. Suzy Weems described the myriad health benefits and risks of alcohol consumption by aging adults.

“Moderate alcohol consumption can improve appetite and nutrition and reduce the risk of several important diseases, including cardiovascular diseases and diabetes,” said Ferreira, a post-doctoral fellow at Haskell Indian Nations University in Lawrence, Kan. Furthermore, Dr. Frederick C. Blow, professor of psychiatry at the University of Michigan Medical School and an expert on alcohol and aging, pointed out in an interview that “even at lower levels of consumption, alcohol can be problematic for older people.”

“Because of an increased sensitivity to alcohol and decreased tolerance as one ages, lower amounts of alcohol can have a bigger effect,” he said. “Older people get into trouble with doses of alcohol that wouldn’t be a problem with a younger person.”

Evidence for the benefits of moderate alcohol consumption comes almost entirely from epidemiological, or population, studies that can reveal important associations but cannot prove cause and effect. There have been few randomised controlled clinical trials of alcohol use to definitively show that alcohol consumed in any amount by any group of people benefits health.

That said, here is what the studies indicate. It’s important to note that most findings refer to moderate consumption, defined as one alcoholic drink a day for women and up to two for men. Also, the benefits are confined to people who do not have ailments, like chronic liver disease, or take medications, like psychoactive drugs, that would render any amount of alcohol risky.

Heart disease and mortality — while many studies have emphasised the benefits of red wine to cardiovascular health and longevity, more than 100 studies in 25 countries have linked these benefits to moderate consumption of any type of alcoholic beverage.

On an average, moderate drinkers 50 and older are less likely to suffer heart attacks and die prematurely than abstainers and heavy drinkers. Immoderate consumption of alcohol — more than three drinks a day — can be hazardous for people of all ages, but especially so for the elderly, who reach higher levels of blood alcohol faster and maintain them longer than younger people.

Yet, Blow said, “We don’t do well identifying older people who are getting into trouble with alcohol.”

Potential hazards include an increased risk of falls and vehicular accidents, a decline in short-term memory, a worsening of existing health problems and interactions with medications that may diminish the effectiveness of some drugs and increase the toxic effects of others.

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