What are the recommendations for alcohol consumption for older adults? You might think this would be an easy question to answer given the years of research on the topic.

But the recommendations are not always straightforward, especially considering that, as we get older, our health status can change sharply. And various health conditions will dictate what makes sense for us, as individuals, when it comes to alcohol consumption. What is easy to recommend: you should always keep your health care team up to date on your drinking habits.

What is the latest research on moderate drinking?

It wasn’t so long ago that some studies showed mostly positive benefits of moderate drinking on an individual’s health. Moderate drinking is typically defined as up to one drink per day for women and up to two drinks per day for men, according to guidelines from organizations such as the National Institute on Alcohol Abuse and Alcoholism (NIAAA). One drink is defined as 1.5 oz of distilled spirits, 5 oz of wine, or 12 oz of beer.

The latest research on alcohol consumption among older adults highlights a complex interplay between its potential benefits and risks. Some newer studies—across all age groups, not just older adults—have now looked more broadly at alcohol consumption over time via a meta-analysis of several research studies.

One global study showed that the risks of drinking outweighed the benefits and concluded that no amount of alcohol was safe.¹ In addition, the American Cancer Society (ACS) released guidelines in 2020 recommending that individuals not drink any amount of alcohol for optimal health and if they want to lower their overall risk of developing cancer. (This is especially true for people who smoke and have a poor diet.) If individuals drink, the ACS recommends it is best to keep to moderate levels.²

At the same time, other studies have shown protective effects of alcohol on cardiovascular health while also highlighting the cancer risk.³ Here’s where an example is helpful. Breast cancer risk is increased in women who drink 2-5 drinks a day. However, more women over the age of 60 die each year from heart disease than from breast cancer. So, drinking in moderation—and not binge drinking—may have some protective cardiovascular benefits for women over 60 that outweigh the risks of developing cancer.⁴

Experts acknowledge that the studies and the various recommendations can be frustrating.

“One of the most challenging factors in the studies is the fact that a lot of drinking occurs in social situations, and it can be difficult to separate out the effects from the social interactions versus the alcohol,” said Melissa Stiles, MD, Professor Emeritus with the University of Wisconsin-Madison Department of Family Medicine and Community Health.

What are the benefits and risks of moderate alcohol intake as we age?

Benefits of moderate drinking

1. Social engagement and quality of life. Sharing a drink with friends or family members can foster a sense of community and connection, improve a person’s mood, and increase social interaction, all of which are particularly crucial for older adults who may face social isolation
2. Cardiovascular health. Moderate drinking, defined as up to one drink per day for women and up to two drinks per day for men, has been associated with a reduced risk of heart disease and stroke. This protective effect is believed to be linked to alcohol's ability to increase levels of "good" cholesterol (HDL) and decrease the formation of blood clots.
3. Cognitive health. Looking at data from a number of studies, researchers found moderate alcohol drinking was associated with change in verbal ability, spatial ability, and perceptual speed.⁵ Not surprisingly, heavy drinking had the opposite effect.

Risks of moderate drinking

1. Increased risk of falls and injuries. Even moderate alcohol consumption—and especially excessive drinking—can lead to an increased risk of falls and injuries in older adults. Melissa Stiles notes that, “As individuals age, their bodies metabolize alcohol more slowly, leading to higher blood alcohol levels and an increased susceptibility to the negative effects of alcohol, such as impaired balance and coordination.”
2. Interactions with medications. Older adults often take multiple medications to manage chronic health conditions, and alcohol can interact negatively with many of these medications. Drinking alcohol while taking certain medications can amplify side effects, decrease the effectiveness of the medication, or even lead to dangerous interactions. It's essential for older adults to consult with their health care providers about potential interactions between alcohol and their medications.
3. Alcohol use disorder. Another concern associated with alcohol consumption among older adults is the risk of developing alcohol use disorder (AUD). While the prevalence of AUD tends to decrease with age, it is still a significant concern, especially among individuals who have been drinking heavily throughout their lives. AUD can have serious health consequences and may require specialized treatment and support.
4. Cancer. The connection between alcohol use and the risk of cancer—especially mouth, pharynx, larynx, esophagus, colon, rectum, breast and liver cancer—is strong, which is what led the ACS to develop its new guidelines. 

Bottom line: Talk to your doctor, and re-assess your drinking habits over time

For years, the medical community has grappled with determining the optimal guidelines for alcohol consumption, especially as it relates to older adults. The latest research offers valuable insights into how alcohol affects older individuals, addressing both the potential benefits and risks associated with its consumption.

Increasingly, researchers are looking at older adults more closely as a subgroup as well as examining how factors such as socioeconomic status, race, ethnicity, and access to health care influence patterns of alcohol consumption and related health outcomes among older adults. Identifying disparities and addressing barriers to care are essential for developing targeted interventions and public health policies.

Whether moderate drinking is OK for you depends on various factors, including your overall health, medication regimen, tolerance to alcohol, and individual preferences. Have an honest and frank discussion with your health care providers to talk through the potential risks and benefits of alcohol consumption for you.

What we do know is that, as we age, the body metabolizes alcohol differently than when we were young, and “we need to be cognizant of that and always re-assess our drinking habits, keeping to light or moderate drinking if one chooses to drink,” according to Melissa Stiles.

Sources 

1. The Lancet. Alcohol use and burden for 195 countries and territories, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. Sept. 22, 2018. Found on the Internet at https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(18)31310-2/fulltext

2. American Cancer Society. American Cancer Society guideline for diet and physical activity for cancer prevention. Found on the Internet at https://acsjournals.onlinelibrary.wiley.com/doi/full/10.3322/caac.21591

3. The Harvard Gazette. More evidence moderate drinking is good for your heart. Also: a reason. June 12, 2023.  Found on the Internet at https://news.harvard.edu/gazette/story/2023/06/is-drinking-in-moderation-good-for-your-heart/

4. Harvard T.H. Chan School of Public Health. Alcohol: Balancing Risks and Benefits. Found on the Internet at https://www.hsph.harvard.edu/nutritionsource/healthy-drinks/drinks-to-consume-in-moderation/alcohol-full-story/

5. Faika Tanjani, et al. Alcohol effects on cognitive change in middle-aged and older adults. Aging and Mental Health. Aug. 30, 2012. Found on the Internet at https://www.tandfonline.com/doi/full/10.1080/13607863.2012.717254