How to Talk to Older Women About Their Alcohol Use

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According to USC Department of Nursing Professor Benita Jean Walton-Moss, PhD, alcohol abuse is often underdiagnosed and undertreated in older women because it is often mistaken for other conditions related to aging. Her research emphasizes the importance of identifying social determinants that may increase patients' risk of alcohol misuse, and outlines a thoughtful approach when screening female patients as a medical professional or caregiver.

Binge drinking may be classically associated with college students, but a recent study shows there’s a new binge drinking population in America: older women. In fact, the Substance Abuse and Mental Health Services Administration reports that adults older than 65 had the highest rate of binge drinking among all age groups, with 5.5 episodes per month. This rise in binge drinking—and alcohol consumption, in general—within the older adult population suggests nurse practitioners and other clinicians should make it a point to routinely screen female patients older than 65 for alcohol misuse. In the graphic below, Nursing@USC’s online FNP program offers suggestions on how to approach this important discussion.


Dangers of Binge Drinking

While excessive alcohol consumption can lead to a host of health complications, including liver trouble, binge drinking presents a specific risk, especially to women. Consuming a high volume of alcohol within a short time frame can increase a woman’s risk for broken bones or concussion from a fall or traumatic injuries due to a car accident. Repeated episodes of binge drinking can trigger chronic disease processes, such as elevated cholesterol levels and a corresponding increase in stroke risk.

Why Are Older Women at Higher Risk?

Various physiological and psychosocial factors affect why older women face greater health risks when over-consuming alcohol. For instance, older women experience a natural decline in both lean body mass and total body water as they age, which causes alcohol to become more concentrated in their system when they drink. On the psychosocial side, women tend to outlive men, which means older women are more likely to experience loneliness, isolation, and depression that can lead to drinking.

How Providers Can Become Better Advocates for Older Women Who Drink

According to USC Department of Nursing Professor Benita Jean Walton-Moss, PhD, FNP-BC, in her paper Alcohol Use and Older Adult Women, “Alcohol abuse in older women is often underdiagnosed and undertreated because it is often mistaken for other conditions related to aging. For example, a problem with balance may be attributed to frailty, increasing social isolation may be attributed to depressed mood, and confusion or memory changes may be attributed to a dementia syndrome.”

Family nurse practitioners, social workers, and other clinicians can address the issue of misdiagnosis—and of binge drinking by older women, in general—by taking several simple steps:

  • Take the time to have a conversation about alcohol use with older female patients
  • Educate women about alcohol serving sizes and recommended intake limits by using the accompanying infographic
  • Make screening for alcohol use a part of every health assessment
  • Identify a woman’s social determinants of health that may lead to increased alcohol use or misuse
  • Maintain a positive, compassionate attitude toward women who may be drinking too much in order to keep the lines of communication open
  • Allow older women to come to a decision on their own about when to seek help for alcohol use

As the Baby Boomer generation continues to age, the issue of alcohol use and misuse among older women will continue to rise. Family nurse practitioners and other clinicians can play a vital role in helping this population identify alcohol misuse by spreading awareness and acting as educators and advocates for women.