Does Alcohol Become More Harmful As We Age?

How does ageing change the body’s response to alcohol, and how is the immune system involved?

When we think about individuals who are likely to consume alcohol in large quantities, we often think about college-aged students or middle-aged adults. However, one important age group is often overlooked: older adults.

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Alcohol consumption in this group, specifically among individuals aged 60 years and over, is increasing at a faster rate than previous generations, raising concerns about the health consequences of alcohol use in ageing populations. Last year alone in the United States, 2.9 million adults aged 65 years or older met the criteria for past-year alcohol use disorder. 

Many older individuals drink socially, while some drink regularly to manage stress or chronic pain. On the surface, this might seem like a harmless coping mechanism, especially since drinking alcohol is a widely accepted social norm. However, the way that alcohol interacts with the ageing body is very different from how it affects younger individuals. As such, as we age, the amount of alcohol consumed can make a big difference in how our bodies respond to it.

Researchers who study alcohol use disorder have generally focused on how heavy alcohol use can lead to a range of harmful physiological and behavioural consequences that can predispose us to certain diseases. However, in recent years, a growing body of literature has begun to uncover how alcohol can turn on our body’s natural defence system, which is also known as the immune system.

As a neuroscientist with research interests in the role of the immune function in health and disease, this newer line of research at the intersection of neuro-immunology, ageing, and substance use has been very intriguing to me. In fact, over the past few years, I have conducted my own research in this area during my time as a Postdoctoral Research Fellow at the University of Texas at Austin.  

So, let me tell you why this is such an important area of research, and what scientists know about the connection between alcohol, ageing, and inflammation.

How Does the Body Change with Age?

Surprisingly or not, as we grow older, our bodies handle alcohol differently than they did in our twenties. This is because older adults generally have less water content in their body and have a slower metabolism. As such, alcohol can stay in the bloodstream for longer periods of time and reach higher concentrations.

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In addition to changes in metabolism, ageing leads to a gradual decline in immune function. This process, referred to as immunosenescence, causes the immune system to become less efficient at fighting infections and repairing damage over time. As a result, we tend to experience chronic, low-grade inflammation that naturally increases as we age, a phenomenon known as inflammaging. This can raise the risk for a variety of age-related diseases, such as cardiovascular, liver, and metabolic diseases, and even cancer.

Thus, older adults are often living in a state where their immune system is overactive. As such, adding alcohol into the mix can further exacerbate the dysregulated immune function that is already occurring naturally from ageing.

What Does Alcohol Do to the Immune System?

Most people know that alcohol can have harmful effects on the liver, but not many people realise just how much alcohol can alter immune function. This is an issue for individuals of all ages; however, older adults can experience exacerbated effects of alcohol on immune function due to immunosenescence. Alcohol can suppress certain immune responses, making it harder to fight infections, while simultaneously triggering inflammation when consumed in excess and/or over long periods of time.

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As a neuroscientist, my research interests lie specifically in how immune cells in the aged brain are impacted by excessive alcohol exposure. Thus, we can study how alcohol affects special immune cells in the brain called microglia, which act as the central nervous system’s cleanup crew. They are the first responders to an immune threat in the brain, and when they detect an immune threat or damage, they can send help signals to other neighbouring cells and can actually remove debris derived from the immune threat to protect other brain cells like neurones! However, if alcohol exposure is excessive and/or chronic, or if the immune system is already primed by ageing, microglia can become overactive. In this dysfunctional state, microglial help signals can do more harm than good. This neuro-inflammation can lead to cognitive decline and potentially accelerate age-related brain changes, potentially leading to other neurodegenerative diseases like Alzheimer’s.

Another important part of this story is the gut! In fact, alcohol can increase gut permeability (a condition often referred to as “leaky gut”), which in turn allows bacterial byproducts to enter the bloodstream. These byproducts can even enter the brain and further cause immune dysfunction, leading to increased inflammation. Since ageing promotes chronic inflammation and weakens immune defences, alcohol-related gut damage can amplify these issues, increasing the risk of inflammation and injury across multiple organs. Thus, the overactive immune function that occurs as a result of ageing likely contributes to the heightened impact of alcohol use in older individuals.

What Happens When Alcohol and Ageing Collide?

As I have discussed above, evidence shows that both ageing and alcohol consumption can independently lead to increased risk of cardiovascular, metabolic and neurodegenerative diseases. Since inflammation is a common thread between ageing and alcohol use, it is plausible that the combination of these risk factors can create a “double hit” that amplifies vulnerability to disease in ageing populations, explaining why older adults who drink heavily are at increased risk of these health issues.

What Can Research on Ageing and Alcohol Teach Us?

Hopefully, I have showed you that studying alcohol use in aged individuals isn’t just about curing hangovers faster! It is really about uncovering how biology, behaviour, and the immune system interact and shape our health over time.

New research is beginning to uncover how the combination of ageing and heavy alcohol consumption can impact our health; however, more work is needed to understand how these risk factors interact with one another, and these mechanisms increasing the risk of illness.  By addressing this gap in knowledge, we can further understand: (1) how alcohol alters the immune system as we age; (2) the mechanisms through which alcohol leads to cognitive decline and increases risk of developing certain diseases; and most importantly (3) what we can do to prevent this.

The Bottom Line

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Studying alcohol use in ageing populations is about identifying a meaningful contributor to disease risk in older adults. Age-related shifts in immune function may intensify alcohol’s effects on conditions such as cardiovascular disease, neuro-degeneration, liver disease, and infection.

The immune system is becoming a topic of interest in research, and people are recognising how central immune function is to how we age and how our bodies respond to substances like alcohol. As more people live longer, understanding this interaction will be essential for improving risk assessment, prevention strategies, and clinical care that supports healthier ageing.