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INTRODUCTION

Unhealthy alcohol use is a common but unrecognized problem in older persons, associated with substantial physical, psychological, social, and legal consequences. Older adults are particularly vulnerable to the adverse effects of alcohol, and as their numbers increase in the population, so too will the number of those with unhealthy alcohol use. Alcohol consumption leads to almost one-fifth of all hospitalizations in older adults.

Definitions

Alcohol use exists on a spectrum, from none, to lower risk use, to unhealthy alcohol use. Unhealthy alcohol use also includes a spectrum, from risky (use associated with important health risks in people without a diagnosis of alcohol use disorder) to alcohol use disorder (AUD).

Thresholds for Alcohol Use in Older Adults

Given that there are different definitions of older adults, we note that for adults who are 65 years old or younger, limits are no more than seven standard drinks per week for women and no more than three drinks on an occasion, and no more than 14 standard drinks per week for men and no more than four drinks on an occasion. The same circumstances that are associated with risks in older adults also apply here, with the addition of pregnancy or trying to conceive, which might be of relevance to the lowest ages of older adults.

A standard drink in the United States is 12 oz of beer, 5 oz of wine, or 1.5 oz of 80-proof spirits (~14 g of ethanol). Of note, alcoholic beverages vary greatly in alcohol content in part because there is variability in products (eg, 100-proof spirits, 14% ethanol wines, fortified wines, craft beers with double or more than usual strength) and in drink sizes at establishments (in many premises, a “martini” cocktail contains the alcohol of two to three standard drinks; a pint of beer is 16 oz and not 12 oz).

Lower Risk Use

Nonhazardous, lower, or low-risk use is alcohol use in someone who has not experienced consequences and use that is not known to be associated with a substantial increased risk of health consequences. For example, an older adult drinking less than seven standard drinks per week who has experienced no negative consequences from alcohol use would be considered low risk.

Unhealthy Alcohol Use

Unhealthy alcohol use is defined as the whole spectrum of use from risky use through AUD.

Hazardous Use or At-Risk or Risky Use

Hazardous or at-risk use is defined as use that increases the probability or risk of a negative consequence but has not necessarily yet resulted in one. For adults over age 65 years, the following are considered risky: more than seven standard drinks per week or more than three drinks on one occasion; any drinking in ...

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