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For forty years, her husband called her "a spirited drinker." But it didn't stop Mattie Nicholson from raising their three daughters and working as a successful free-lance photographer. But by age 72, the two martini lunch, followed by two glasses of wine before dinner was finally catching up with her.

As her afternoon naps became longer and longer, Mattie's husband began to grow concerned. The vitality and exuberance he loved about his wife seemed to be gone. Finally, the lethargy, a hand tremor, and elevated blood pressure convinced her to see a physician. He advised less alcohol, along with several other tests. Although her kids had casually suggested she drink less, it took a stern lecture from her doctor to make the difference. For six months, Mattie cut back on her drinking and attended weekly counseling sessions. One year after her initial visit to the doctor, she gave up drinking entirely.

"I can't believe how much better I feel," Mattie comments. "Twice a week I'm playing golf again, something I haven't done in over ten years. My daily naps are a thing of the past and we're planning a trip to see our grandkids."

Although Mattie drank all her adult life, not all alcohol problems are of long duration. Some drinking problems develop later in life, following retirement, divorce, loss of employment or death of a spouse. In addition, alcohol abuse is frequently overlooked in the elderly because they can be somewhat cut off from the outside world.

A national survey of over 3800 Americans over age 65 revealed about half are current drinkers and a quarter drink daily. Intermittent heavy drinking (five drinks on one occasion) and regular heavy drinking (more than two drinks for men and more than one drink a day for women) were common among the survey respondents. Although most adults would not consider two or three alcoholic drinks a day to be "heavy drinking", in fact, the National Institute on Alcohol Abuse and Alcoholism considers one drink a day to be the acceptable limit for people over 60 years old. They classify a drink as 12 ounces of beer, a standard 5.5-ounce glass of wine, or a 1.5-ounce shot of hard liquor.

Why such a low limit? Once ingested, alcohol moves to the body's lean muscle mass and water stores. But, beginning after age 50, (with some variations) our bodies progressively lose muscle mass and water. So, a given amount of alcohol results in a higher concentration than in younger people.

Plus, an older person's stomach produces less of an enzyme called alcohol dehyrogenase, which breaks down the alcohol. And, if they are taking commonly prescribed medications such as Tagamet or Zantac, the enzyme is further suppressed. The result: more unmodified alcohol gets into the bloodstream.

Alcohol's effect on the liver is another important consideration for those over 60. Even in seniors without liver disease, this vital organ is pressed into daily service to metabolize prescription drugs. Drinking alcohol imposes an additional burden on the liver, which can affect blood levels of both alcohol and medications.

According to a spokesperson from the American Medical Association, physicians can be reluctant to diagnose an elderly person as an alcoholic, because they're unsure how to treat the disease or are pessimistic the person will be able to cope with the illness. Others are not inclined to believe that the "nice little old lady" is an alcoholic. But, in actuality, seniors have among the highest rates of success in treatment.

A study of brief intervention techniques which have helped combat problem drinking in the general population indicates the methods used can also work for seniors. The research found elderly patients who received both a health booklet and brief visits with health care professionals, including two 15-minute visits with a doctor, experienced reductions in seven-day alcohol use and binge drinking episodes. These brief interventions included discussing the adverse effects of alcohol and the patient's reasons for drinking, among other topics. In addition, the physician gave the senior a "drinking agreement" in the form of a prescription. Finally, they received a follow-up phone call from a clinic nurse, two weeks after each physician visit.

While warning signs that a senior is an alcoholic are more subtle than in a younger person, you can learn to spot them. Signs include increased indications of self-neglect or letting the house or apartment become cluttered and dirty, confusion over time of day, their surroundings etc. Other warnings might be repeated falls and accidents, consuming alcohol on a daily basis, and drinking at home alone, rather than at bars or social occasions. Malnutrition is also sited as a possible indication of a drinking problem.

Yet, approaching the problem can be extremely difficult for an adult child. Studies show most older people view alcoholics and substance abuse as a character flaw, not a disease. Another barrier which keeps the elderly from contact with an addiction treatment provider is signs of addiction are often interpreted as quirks associated with the aging process. Even health care providers can fail to distinguish between the two.

If you suspect an older family member has a drinking problem, gently confront the person without judgment and choose your words very carefully. You need to show you accept them as someone with needs. Also, this age group grew up in a time when alcoholism was considered a social stigma or sin. So, it's best to refer to it as a "drinking problem," rather than alcoholism. The elderly drinker needs to have something to replace the dependency on alcohol, such as regular exercise, taking care of a pet, reading, meditation or prayer.

It's also important to make a list of all the prescription medications the person is on and take it to their physician, who can monitor over-all drug needs in conjunction with the drinking problem.

There's a widespread myth which says older people can't change, but that simply isn't true. If you doubt it, just ask Mattie.