Alcohol Worsens 'Inflamm-Aging' in the Elderly

Pauline Anderson

June 29, 2016

Researchers are raising red flags about alcohol consumption in older individuals because of concerns about a phenomenon known as "inflamm-aging."

Investigators at the University of Colorado Denver have shown that alcohol has a greater immunosuppressive effect in elderly individuals that compromises their ability to battle infection.

"Our laboratory has been studying inflammatory and immune responses in the aged for well over a decade," study investigator Brenda J. Curtis, PhD, research assistant professor at the University of Colorado Denver, said in a release.

"We know that even healthy elderly individuals have an elevated basal inflammatory state, known as 'inflamm-aging.' Advanced age alone is a risk factor for a poor prognosis after injury or infection. Adding alcohol to the fragile immune milieu of the aged reduces their ability to fight infections," Dr Curtis added.

The researchers note that the consequences of alcohol consumption may be especially severe if older patients also take medications for diseases such as hypertension and diabetes. Like alcohol, many of these medications are metabolized in the liver.

"Alcohol has a longer lasting and more potent effect in older people than in younger people," study investigator Elizabeth J. Kovacs, PhD, director of burn research and professor, Division of Gastrointestinal, Tumor and Endocrine Surgery, Department of Surgery, University of Colorado Denver, told Medscape Medical News.

The findings were presented at the 39th Annual Research Society on Alcoholism Scientific Meeting in New Orleans.

The investigators' work, as well as that of others, suggests that excessive alcohol consumption may increase inflammation levels in the body by changing the microbiome. Alcohol, Dr Kovacs said, may contribute to leaking of bacterial content into underlying tissue, causing inflammation.

"You need perfect, tight junctions that keep the epithelial cells that line the intestines intact so that food and other things go through, nutrients are absorbed, and bacteria in the lumen, the center of the intestines, does not leak into the underlying tissue."

Dr Kovacs and colleagues examined the impact of aging and alcohol on the immune system and inflammation. Specifically, they looked at whether alcohol intoxication alters the innate immune response to infection in aged mice.

They administered ethanol (1.1 g/kg) in young and aged BALB/c mice, after which they induced intratracheal infection. Older mice who received ethanol prior to lung infection had worse pulmonary pathology, including increased cellularity and alveolar wall thickening, relative to their young counterparts. In addition, inflammatory foci in the lungs were larger.

In other experiments, researchers isolated alveolar macrophage from the lungs of young and aged mice and cultured the cells in vitro with ethanol for 3 hours with or without intraperitoneal lipopolysaccharide (LPS) stimulation for an additional 18 hours.

The in vitro studies showed that ethanol exposure reduced the inflammatory response to LPS in BAL cells from young mice but not in BAL cells from aged mice.

Taken together, these studies demonstrate that ethanol intoxication in aged mice diminishes the pulmonary response to infection, perhaps through modification of macrophage activation and signaling.

Similarly, the effects of alcohol in the elderly are more potent than they are in younger individuals, in part because of the proinflammatory state of the elderly, said Dr Kovacs. Older individuals also have decreased lung function and cough strength, which further escalates the risk of developing pneumonia, she added.

As they get older, many patients develop conditions such as Alzheimer's disease, cancer, hypertension, or osteoporosis. These conditions may be worsened by the consumption of alcohol.

Growing Problem?

It appears that, increasingly, older people are turning to alcohol, said Dr Kovacs. "According to the literature, 16% of people over age 55 drink heavily, and of those over 65, 11% to 12% drink more than they should."

In addition, because people now live longer, a greater proportion of the elderly population will be consuming alcohol.

The National Institute on Alcohol Abuse and Alcoholism defines low-risk drinking for women as having no more than three drinks on any single day and no more than 7 drinks per week. For men, low-risk drinking is defined as having no more than four drinks on any single day and no more than 14 drinks per week.

The Substance Abuse and Mental Health Services Administration defines heavy drinking as consuming five or more drinks on the same occasion on each of 5 or more days in the past 30 days.

It does not help to have a daily "happy hour" in retirement homes, which Dr Kovacs said may not be that uncommon. In such settings, groups of older people with compromised immune systems may be at higher risk for community-acquired infections.

In addition, alcohol consumption places older individuals at risk for falls and fracture. Further, said Dr Kovacs, the elderly take longer to recover than their younger counterparts do.

Studying the effects of alcohol in older individuals has been a neglected area of research, but Dr Kovacs said she and her colleagues aim to change that.

39th Annual Research Society on Alcoholism Scientific Meeting: Presented June 28, 2016.

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