Alcohol Tolerance as You Age: What to Know as You Get Older

Alcohol tolerance tends to decrease as we age due to changes in our bodies as we get older, such as reduced liver function and decreased muscle mass.

For many adult Americans, a nightcap is a welcome ritual at the end of the workday. And, as it turns out, it’s a habit that many continue long past retirement. According to the National Survey on Drug Use and Heavy Drinking, nearly 39% of adults aged 65 or older report consuming 1-2 drinks per day while 16% report drinking 2 or more drinks a day.

“While an occasional cocktail isn’t a problem,” says Jaines M. Andrades, DNP, AGACNP-BC, of Baystate Trauma and Acute Care Surgery, “what these happy hour participants may not realize is that how their body responds to and processes alcohol changes as we age. If you are someone who regularly enjoyed two glasses of wine in the evening, over time you may find that it only takes one glass to bring on the previous two-glass level of intoxication.”

Why Can't I Drink As Much Alcohol Anymore?

As we age, our bodies metabolize alcohol differently than when we were younger, so our drinking habits need to change. The increased sensitivity to alcohol as we age can be more dangerous when combined with worsening vision and balance, increased medication use, and the types of medications we take as we age.

You're More Sensitive to Alcohol as You Age

You may have noticed as you get older, you're more sensitive to alcohol—you may feel intoxicated faster and with less alcohol, or have worse hangovers, or just respond differently to alcohol than you did in the past. As for what’s behind the changing physical response to alcohol, Andrades cites a couple of key factors, including decreased muscle mass (replaced by fat tissue) and reduced liver function.

“First, as we age, muscle mass is replaced by fat tissue,” she says. “This leads to having a higher blood alcohol content when compared to consuming the exact same amount of alcohol when you were younger. Without realizing, you’ll find yourself feeling drunker faster.”

Andrades also notes that reduced liver function impacts how older people may be affected by alcohol. “A weakened liver basically leaves a larger amount of alcohol in your bloodstream. So, even if you’re drinking the same amount you always have, the intoxicating effects will be much stronger.”

She emphasizes that the intensified effects are particularly dangerous for older adults who may already have slower reaction times and poor balance.

“The greatest risk,” she notes, “is falling. Between balance issues and impaired vision, it’s really a recipe for disaster.”

Alcohol and Medication: A Potentially Deadly Cocktail

With nearly 9 in 10 adults aged 65 or older taking daily medication and more than 4 in 10 taking 5 or more medications per day, it’s important to consider how those medications may interact with alcohol.

Andrades says, “Many medicines—whether prescribed or over the counter—can be dangerous or even deadly when mixed with alcohol. If you drink, it’s absolutely essential to speak to your doctor or pharmacist whenever you add a new medication about any potential interactions or issues.”

For example, she notes, many seniors are prescribed medication for high blood pressure. “However, alcohol increases blood pressure which basically zeroes out what the medication was supposed to do for you. However, drinking while on this medication can also increase the risk of side effects including feeling dizzy or light-headed. It may be hard to distinguish if what you’re feeling is a result of the alcohol or the medication.”

Similarly, drinking alcohol with medicine for mental health—antidepressants and anti-anxiety medications—can also leave you feeling more drunk than usual and unsteady on your feet.

“These intensified effects should be of particular concern to the many seniors who take anti-coagulants, such as Coumadin,” she adds. “The increased level of impairment increases the risk of falling and, if you’re on a blood thinner, any resulting bleeding can be excessive or just more than normal.”

Strategies to Protect Your Health if You Drink Alcohol

Andrades encourages anyone who drinks to be mindful of how many ounces of alcohol you’re consuming.

“In the case of alcohol, it’s not so much about the size of the drink that matters as it is how much alcohol by volume that drink has in it,” she says. “If you’re enjoying a drink that has a high alcohol by volume level (labeled ABV on alcohol packaging), be mindful that one glass may be equal to two of whatever someone else is drinking. Don’t try to keep up.”

She also notes that when dining out, very often, the amount of alcohol poured—be it wine or beer—is greater than what’s considered a single serving. “You may be accustomed to a 12-ounce beer at home but may be served a 16-ounce glass when out at a restaurant. In the case of wine, a single glass of wine out may be equal to two servings of what you’d pour yourself at home. That doesn’t mean you need to skip the drink, but you do need to be mindful of exactly how much you’re consuming.”

Talk to your primary care doctor about your alcohol consumption—they can help you understand potential medication interactions and additional risks as you age. If you’re looking to reduce your alcohol intake, or try an entirely sober lifestyle, your doctor can help with that as well.