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Editorial
Open Access
Sleep and Hazardous Drinking in the Elderly: A Clarion Call for Increased
Clinical and Translational Research
Ilana S. Hairston
School of Behavioral Sciences, Academic College of Tel Aviv – Jaffa, Israel
*Corresponding author:
Ilana S. Hairston
School of Behavioral Sciences
Academic College of Tel Aviv – Jaffa
Rabeno Yeruham, Box 8401
Jaffa 61083,
Israel Tel: +972-3-6802558 E-mail: ilanahai@mta.ac.il
Received July 10, 2012; Accepted July 12, 2012; Published July 14, 2012
Citation: Hairston IS (2012) Sleep and Hazardous Drinking in the Elderly: A Clarion
Call for Increased Clinical and Translational Research. J Addict Res Ther 3:e109.
doi:10.4172/2155-6105.1000e109
Understanding factors that contribute to the onset and maintenance
of alcohol use disorders (AUD) has been a central goal of public health
policy and federal funding mechanisms for several decades. To date,
the majority of empirical studies describing trajectories of alcoholism
focused primarily on the period between drinking onset and young
adulthood [1]. By contrast, there is a dearth of research focusing on
drinking behaviors during late adulthood through midlife and aging.
Consequently, risk factors that contribute to the onset and maintenance
of AUD later in life are not well defined.
Although drinking rates decline with age, older adults may
continue to engage in at-risk drinking behaviors [2-4]. In fact, it is
now increasingly recognized that alcohol-related problems do not only
concern the young population, but also occur in healthy older adults
ranging between 10-15%, and around 35% in those seeking care for
other health problems [5-7]. Further, a recent report from the Centers
for Disease Control and Prevention, while providing additional evidence
for the age-dependent decline in alcohol consumption, also finds that
the frequency of binge drinking did not decline, and in fact was highest
(5.5 episodes per month) in the 65+ age group [8]. The beneficial effects
of moderate alcohol consumption not withstanding [9,10], given that
physiological processes decrease the ability to metabolize ethanol [11],
the immediate and long-term effects of hazardous drinking in older
persons may be more severe than those observed in young adults.
This is of increasing significance as demographic evidence indicates
that the elderly are the fastest growing segment of the population
[12,13]. Thus, older adults are likely to live longer, carrying into
later life the cumulative effects of physical and psychiatric problems.
Hence, understanding the mechanisms that underlie the onset and/
or maintenance of hazardous drinking in older adults is essential
for developing appropriate and adequate interventions to minimize
harm and promote the health of this rapidly growing segment of the
population.
A potential underlying cause for excessive drinking in older
adults is sleep disruption. Sleep disturbance often accompanies AUDs,
persisting into periods of prolonged abstinence [14,15], and, in nonalcoholic
primary care patients, ages 60 and older, using alcohol for
sleep was associated with hazardous drinking behaviors [16]. Although
some evidence exists from the child and adolescent risk literature that
sleep difficulty predicts behavioral problems linked to addictions [17-19], little attention has been focused on the mechanistic role that sleep
disruption may play in increased risk for AUD in general, and in the
aged population in particular.
Aging is associated with profound changes in sleep patterns [20-22]
and a weakening of the circadian system [23] which likely contributes
to the sleep disruption and daytime fatigue observed in older adults
[24]. Even though older adults seem to be less sensitive to the cognitive
impairment that ensues from acute sleep deprivation or restriction,
compared to younger individuals [25], they are not immune to the
long-term or chronic effects of persistent sleep disruption. Chronic
sleep difficulty is implicated in impaired emotional as well as cognitive
functioning [24,26-29]. Thus, the emotional and cognitive mechanisms
impacted by sleep difficulty may therefore be the foundation for the risk of hazardous drinking behaviors in older adults. Arguably,
developing adequate detection and intervention tools would benefit
from hypothesis-driven translational research. Such hypotheses can
be derived from the already existing literature on the effects of sleep
disruption on cognitive and emotional functions, and the role of
impacted functions in risky behaviors.
The Dynamic Integration Theory proposed in 2003 by Gisela
Labouvie-Vief [30] suggests that positive self- and emotional well-being
requires the integration of the ability to optimize happiness with the
ability to tolerate tension and negativity. Through life experience, older
adults are adept at such integration under moderate emotional arousal
, demonstrating greater resilience and competent emotion regulation
under conditions of normative emotional challenges, compared to
younger adults; thereby increasing their overall experience of wellbeing
[31,32]. However, when confronted with more emotionally and
cognitively demanding situations, that impose greater demands on
cognitive resources which, in turn, impinge on conscious control of
executive processes, older individuals demonstrate greater cognitive
impairment relative to younger adults, including decreased executive
control and inhibitory functioning [33,34].
Thus, under the emotional and cognitive challenge of impaired
sleep, older adults may display more simplified, stereotypical thinking,
with compromised emotion regulation in situations that require
executive control [35], thereby impairing their ability to adequately
monitor alcohol intake, whether it is used to improve their sleep, their
mood, or reduce anxieties. Such a hypothesis is also consistent with
models of addiction that postulate that substance use is a behavioral
mechanism aimed at reducing, and subsequently avoiding negative
affect [36]. Hence, to alleviate the negative affect associated with
chronically disrupted sleep, older adults may use alcohol, perhaps
unaware of the changes in alcohol metabolism associated with age.
In conclusion, as the ageing population in the US and developed
countries continues to grow, the number of elderly people with
alcohol use disorders will increase concurrently [2-4]. With minimal
understanding of the mechanisms that underlie hazardous drinking
behaviors, and a tendency to underestimate alcohol misuse in older
people, or perceive it as reasonable in the context of poor health and
changing life circumstances, alcohol use disorders in older adults may
prove to be a significant health hazard. In some sense, this parallels
the attitude towards sleep difficulty in this age group, which is also perceived as being secondary to the aging process and decreased
health. It thus behoves us, both as researchers and as clinicians to focus
a spot-light on the health concerns of this expanding number of older
members of society, and to better understand the mechanisms that
underlie risky alcohol and other substance-related behaviors, in order
to minimize harm and improve the overall health and well-being of our
senior citizens.
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