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August 29, 2019/Geriatrics/Research

Binge Drinking: Often Unrecognized in Older Adults

How to detect alcohol abuse in geriatric patients


More than one in 10 Americans age 65 and older are binge drinkers, says a study recently published in Journal of the American Geriatrics Society. Cleveland Clinic geriatrician Ronan Factora, MD, isn’t surprised.


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“This study highlights a problem that geriatricians and other primary care providers probably don’t recognize frequently enough,” he says.

The study asked nearly 11,000 older adults if, in the previous 30 days, they had consumed multiple drinks at one time (five or more for men, four or more for women). That’s a question most healthcare providers never ask.

Screening for excessive alcohol use is standard for geriatric visits because drinking can contribute to cognitive issues, mood disorders, falls and mobility problems. However, providers usually ask patients to estimate their average number of drinks per day or per week, says Dr. Factora. And that question may not reveal binge drinking.

“If you consider an acceptable number of drinks per day to be two for a man and one for a woman, that becomes 14 drinks per week for a man and seven for a woman,” he says. “But binge drinking can fall below that radar. There’s still a health hazard if someone consumes, say, five drinks at one time but sporadically.”

The study’s one-in-10 statistic actually may be low, adds Dr. Factora. Some in the medical community define binge drinking in older adults as three drinks at a time, rather than the four or five drinks considered in the study.

Effects of alcohol on older bodies

A little alcohol can go a long way in older adults, who have less body water than younger adults and are more easily intoxicated. There also may be changes in the aging liver, which affects how quickly alcohol is metabolized. Especially if a patient is taking medications that affect liver function, such as antiseizure or psychotropic medications, the effects of alcohol may linger, says Dr. Factora.

“For patients taking antidepressants or sleep medications, drinking alcohol is especially risky,” he says. “Alcohol can enhance the effects of these drugs, potentially causing excessive drowsiness, confusion and dizziness, which can lead to falls.”

Drinking alcohol while taking blood thinners, including aspirin, may increase risk of bleeding in the stomach. However, Dr. Factora notes that research is lacking on the impact of blood thinners with episodic binge drinking.

Discussing substance use with patients

Discussing alcohol use is a standard part of patient evaluation, says Dr. Factora. He asks his patients five questions:

  1. Do you drink alcohol?
  2. How often do you drink? “Most people say they drink occasionally, such as on holidays or when dining out,” says Dr. Factora. “But then I probe with follow-up questions: Do you drink once a week? A couple of times a week? That helps me identify patients who may be drinking more frequently than they first admitted.”
  3. What do you drink? Glasses of wine? Cans of beer? Shots of liquor?
  4. How much do you drink? “People interpret ‘one drink’ or ‘one glass’ differently,” says Dr. Factora. “One glass of wine filled to the top could actually equal two to three drinks. I ask them to use their hands to visualize quantity.”
  5. Do you ever drink three or more drinks at a time? This question is most valuable for identifying episodic binge drinking, he says. “It’s not enough to ask how many drinks per day or week.”


Dr. Factora also inquires about everyday behavior and activities. Impairments (such as inability to manage finances) and recurring events (such as falls or auto accidents) can reveal possible alcohol or drug use. So can weight loss or low body weight — if patients are substituting regular meals for alcohol.

“As casually as I ask about medical history, smoking and drinking, I ask about marijuana, heroin and cocaine,” says Dr. Factora. “I tell them that I need to know about everything they consume in case it interacts with medications I prescribe.”

Caring for patients with substance abuse

If patients show signs of substance abuse, or if drugs or alcohol are contributing to functional problems, Dr. Factora advises abstinence and refers patients to resources to help them control use.

“The first step is identifying the drug or alcohol problem,” he says. “Patients tend to offer more information if I seem nonjudgmental. Asking about alcohol and drug use in a nonchalant way often yields results.”

The second step is explaining how substance abuse can be linked to the issues they’ve been experiencing, such as physical instability or memory problems. Tying alcohol or drug cessation to personal health goals influences patients to make changes to live the life they desire.


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