What To Know About Alcohol and Aging

If you feel like you’re getting more sensitive to alcohol as you get older ... well, it’s not your imagination. The way we process alcohol changes with age, says geriatrician Kenneth Koncilja, MD.

Why alcohol hits differently as you get older

The basic process by which your body metabolizes (processes) alcohol doesn’t change. But as you age, it becomes harder for your body to do. Here’s why:

• Your liver enzymes change, which slows your body’s ability to break down booze like it used to.
• Your lean muscle mass decreases, causing more alcohol to remain in your bloodstream and magnifying its effects.
• Medications can interact with alcohol, which may change the way drinking makes you feel. It can also make your medications less effective.
• Other health conditions can play a role. Conditions like obesity and diabetes may affect your liver function and make it harder for your body to process alcohol.

Dr. Koncilja takes a closer look at why drinking feels different as you get older.

You can’t metabolize alcohol as well

“Your liver just isn’t as resilient as you get older,” Dr. Koncilja says. “So, it might not process alcohol as efficiently it does it does when you’re younger.”

Alcohol is mostly processed by enzymes in your liver, which break it down into chemicals that circulate throughout your body. Eventually, they morph into carbon dioxide and water that you pee out. But as you age, those liver enzymes change.

“We’re all born with varying levels of enzyme activity to begin with,” he continues. “Then, as you get older, other factors start to compete for those enzymes’ attention — like health issues that affect your liver function and medications you take that also need to be broken down by your liver.”

There’s another issue, too: As you age, your circulation slows. With less blood flowing through your liver, the whole metabolizing process slows down — and toxic metabolites from alcohol start to build up.

Your body composition changes

You lose about 3% to 8% of your lean muscle mass each decade after age 30. That means you have less muscle tissue available to retain water. That plays a role in alcohol does to your body — namely, that drinks start hitting you harder and faster.

“Because we lose lean muscle mass with age, a higher concentration of alcohol remains in the bloodstream,” Dr. Koncilja explains. “So, you feel more intense effects from the same amount of alcohol.”

These effects may include:

• Short-term memory problems and poor judgment
• Being off-balance or uncoordinated (which raises your risk of falls)
• Extra sleepiness or sluggishness
• Decreased attention span
• Increased risk of dehydration

Medications can interact with alcohol

When you’re taking certain medications, drinking can affect you in ways that you haven’t experienced before.

“Combining alcohol with certain drugs can affect how those drugs make you feel,” Dr. Koncilja says. “It can also contribute to higher blood alcohol levels than when you weren’t on medication.”

Plus, many medications compete with alcohol to be processed by your liver. It’s a competition that alcohol always wins — which means your liver doesn’t have the same bandwidth to process your medications the way it should. This can make them less effective and cause dangerous interactions.

Here are some examples:

• Sedatives become more potent.
• The effect of blood thinners is amplified, which raises the risk of serious bleeding.
• Blood pressure medications don’t work as well, increasing your risk of stroke and other issues.

Other health conditions play a role, too

“As you get older, you’re more likely to develop health problems that you didn’t have when you were young,” Dr. Koncilja says. “That compounds the effects of alcohol, especially when it comes to heavy drinking.”

Conditions that can have an effect on your liver function and make it harder for you to process alcohol include:

• Diabetes
• Heart disease
• Obesity
• Cancer

Aging and alcohol tolerance: What it means for you

Alcohol’s effects become more pronounced as you age. You may experience:

• Slower recovery times: All the changes we’ve discussed can mean that hangovers hit harder and take longer to bounce back from than they did in your 20s or even 40s.
• More sleep troubles: No matter your age, alcohol disrupts sleep and makes the sleep you do get less restful. “In general, alcohol compounds the sleep problems that are common after age 65,” notes Dr. Koncilja.
• Higher risk of injury: Aging increases your fall risk, and the consequences of alcohol-related falls tend to be more serious after age 65. “Alcohol is associated with a significant portion of falls with fractures in older adults,” he adds.
• Other health effects: Alcohol raises blood sugar, increases blood pressure and worsens sleep, all of which negatively affect your health. It can also make existing conditions worse (like chronic pain and heart disease).

Heavy drinking comes with even greater risks:

• Liver disease: It takes longer for your body to metabolize alcohol than it does to absorb it. So, heavy drinking keeps alcohol in your bloodstream longer. This allows a chemical called acetate to build up in your liver, which causes cirrhosis over time.
• Cognitive decline: There’s no other way to put it: Long-term heavy drinking is bad for your brain. It raises your risk of many types of cognitive impairment, including alcohol-related dementia.
• Mental health concerns: Studies show that older adults may turn to alcohol as a way to cope with loneliness and isolation. But heavy alcohol use can also contribute to depression and other mental health issues.
• Nutritional deficiencies: If you drink more calories than you eat, you risk nutritional deficiencies (which are also more common with age). “The consequences range from minor to major,” says Dr. Koncilja. “Folate deficiency causes anemia, while thiamine deficiency can trigger delirium.”
• Cancer: Alcohol is a chemical carcinogen, or a substance known to raise your risk of cancer. The more alcohol you consume, the higher your risk of developing certain types of cancer.

Should you stop drinking?

Dr. Koncilja encourages everyone, especially older adults, to examine their relationship with drinking.

“Take a pulse on your alcohol habits and reassess whether they’re healthy,” he advises. “You don’t necessarily have to stop drinking altogether. But if you’re drinking heavily, it’s important to learn to cut back.”

• Stay within the limits. The current recommendation is no more than one drink per day (and no more than seven per week) after age 65.
• Know about medication interactions. Talk to your healthcare provider about the medications you take and how they interact with alcohol.
• Try nonalcoholic options. Dr. Koncilja suggests experimenting with nonalcoholic options and even flavored seltzer water with lime, which can mimic a cocktail in social settings.

But if you’re ready to stop drinking entirely, you’ll experience nothing but benefits to your body.

“If you’re worried — especially about memory problems — then just don’t do it. Just don’t drink alcohol,” Dr. Koncilja states. “And if you need help quitting, your healthcare provider is there to help you figure out the best way forward.”