I’ve always enjoyed a cocktail or glass of wine with dinner, but recently I’ve noticed that if I decide to have a second drink it affects me more than it ever has before. As we age, our relationship with alcohol undergoes significant changes that many people don’t fully understand. What might have been a manageable glass of wine or cocktail with dinner in your thirties can have dramatically different effects in your sixties and beyond. Understanding these changes is crucial for maintaining health and safety as you grow older.
How Aging Changes Alcohol Processing
The human body’s ability to process alcohol diminishes considerably with age, creating a perfect storm of physiological changes that make older adults more vulnerable to alcohol’s effects. These changes begin gradually in middle age and become more pronounced as we enter our senior years.
Decreased Lean Body Mass and Increased Fat: As we age, our bodies naturally lose muscle mass and gain fat tissue. Since alcohol distributes primarily in water-rich lean tissue rather than fat, older adults have less space for alcohol to distribute throughout our bodies. This means the same amount of alcohol that once felt manageable now results in higher blood alcohol concentrations.
Reduced Water Content: Our total body water content decreases significantly with age, dropping from about 60% in young adults to roughly 50% or less in older adults. With less water to dilute alcohol, even modest amounts can lead to higher concentrations in the bloodstream and more pronounced effects.
Slower Metabolism: The liver, our body’s primary alcohol-processing center, becomes less efficient with age. Liver enzymes responsible for breaking down alcohol work more slowly, meaning alcohol stays in the system longer. What once took an hour to metabolize might now take two hours or more, prolonging both the effects and potential for harm.
In sum: Studies now show that chronic and heavy alcohol consumption can actually accelerate the body’s biological aging, making tissues and organs age faster than our calendar years suggest. This effect is especially strong with liquor and binge drinking, both driving up markers of cellular aging more than moderate beer or wine consumption. A drink that felt “fine” at 40 might lead to wooziness or poor judgment at 70—not because of frailty or weakness, but because of predictable physiological changes.
Physical Effects of Alcohol on the Aging Body
The aging process makes our bodies more susceptible to alcohol’s negative effects across multiple systems. These changes can have serious implications for both immediate safety and long-term health.
Cardiovascular Impact: While moderate alcohol consumption has sometimes been associated with heart benefits in younger adults, aging changes this equation. Older adults are more likely to have existing cardiovascular conditions, and alcohol can exacerbate high blood pressure, irregular heart rhythms, and heart disease. The dehydrating effects of alcohol become more problematic as our bodies become less efficient at maintaining fluid balance.
Brain and Cognitive Effects: The aging brain is particularly vulnerable to alcohol’s effects. Alcohol can worsen age-related cognitive decline and increase the risk of falls due to impaired balance and coordination. Even small amounts can significantly impact reaction time, judgment, and memory in older adults. Regular consumption may accelerate cognitive decline and increase dementia risk.
Bone Health: Alcohol interferes with calcium absorption and bone formation, making older adults more susceptible to osteoporosis and fractures. Since aging already increases fracture risk, alcohol consumption compounds this danger significantly.
Sleep Disruption: While alcohol might initially seem to help with sleep, it actually disrupts sleep quality, particularly in older adults who already face age-related sleep challenges. Poor sleep quality can cascade into numerous other health problems, from weakened immunity to increased fall risk.
Dangerous Drug Interactions
Perhaps the most critical concern for older adults and alcohol consumption is the potential for dangerous interactions with medications. Adults over 65 take an average of four prescription medications, and many of these can have serious interactions with alcohol.
Blood Thinners: Medications like warfarin (Coumadin), apixaban (Eliquis), and even aspirin can have dangerous interactions with alcohol. Alcohol can either increase bleeding risk to dangerous levels or, paradoxically, reduce the medication’s effectiveness, increasing stroke risk.
Diabetes Medications: Alcohol can cause unpredictable blood sugar changes, particularly dangerous for those taking insulin or medications like metformin. The combination can lead to severe hypoglycemia, which can be life-threatening.
Blood Pressure Medications: ACE inhibitors, beta-blockers, and diuretics can all interact with alcohol, potentially causing dangerous drops in blood pressure, dizziness, and increased fall risk.
Pain Medications: The combination of alcohol with opioid pain medications can cause severe respiratory depression with possibly fatal results. Even over-the-counter pain relievers like acetaminophen, when combined with alcohol, can potentially cause liver damage.
Sleep Aids and Anxiety Medications: Benzodiazepines like lorazepam (Ativan) or sleep medications like zolpidem (Ambien) can have amplified sedating effects when combined with alcohol, increasing risk of falls, accidents, and respiratory depression.
Antidepressants: Many older adults take antidepressants, and alcohol can interfere with their effectiveness while increasing side effects like drowsiness and coordination problems.
Key Takeaway: Even small amounts of alcohol can react with medications, increasing accident risk and threatening life. Always consult a healthcare provider about drinking while taking any medication.
Guidelines for Safer Alcohol Consumption
The National Institute on Aging recommends that adults over 65 limit themselves to no more than one drink per day and no more than seven drinks per week, significantly lower than recommendations for younger adults. However, even this guideline may be too liberal for many older adults, particularly those taking medications or with underlying health conditions.
Key Safety Strategies: Always consult with healthcare providers about alcohol consumption and medication interactions. Keep a detailed list of all medications, including over-the-counter drugs and supplements, and review them regularly with doctors and pharmacists. Consider the cumulative effects of multiple medications when making decisions about alcohol consumption.
Timing Matters: If you choose to drink, timing can be crucial. Avoiding alcohol within several hours of taking medications can reduce interaction risks, though some medications require longer intervals.
Recommendations: According to the National Institute on Alcohol Abuse and Alcoholism, adults over 65 should:limit consumption to no more than one standard drink per day;have at least two alcohol-free days per week; avoid alcohol entirely when taking certain medications or managing specific chronic illnesses. A standard drink is defined as:12 oz of beer (5% alcohol), 5 oz of wine (12% alcohol), or 1.5 oz of distilled spirits (40% alcohol). Please note that this is smaller than most restaurant or cocktail lounge servings, particularly for distilled spirits that usually average about 3 oz or more per drink.
For some people, the safest level of drinking may be none at all—particularly if falls, liver disease, or cognitive impairment are concerns.
Warning Signs
Alcohol misuse in older adults is often overlooked. Its symptoms can mimic—or be mistaken for—age-related issues like memory loss, depression, or poor balance. Some warning signs include: frequent falls or bruises, unexplained memory lapses or confusion, changes in sleep patterns, neglect of hygiene or nutrition, social withdrawal or irritability, mixing alcohol with medications—intentionally or unintentionally.
Even if alcohol isn’t consumed in large quantities, it can still be harmful if consumed regularly in combination with underlying health conditions or with medications—both prescription and over the counter.
The Bottom Line
Aging fundamentally changes how our bodies process and respond to alcohol, making us more vulnerable to both immediate dangers and long-term health consequences. The combination of physiological changes, increased medication use, and higher baseline health risks means that alcohol consumption strategies that worked in our younger years may no longer be safe or appropriate.
An important step is open communication with healthcare providers about alcohol consumption and its potential interactions with medications and health conditions. For many older adults, reducing alcohol consumption or abstaining entirely becomes the safest choice for maintaining health, independence, and quality of life in their later years. I still enjoy the occasional drink, just not as much or as often as when I was younger—like many things in life.
Resources
The Substance Abuse and Mental Health Services Administration (www.SAMHSA.gov) has a helpline at 1-800-662-HELP (4357).
National Institute on Aging (https://www.nia.nih.gov/health/alcohol-misuse-or-alcohol-use-disorder/facts-about-aging-and-alcohol)
Mayo Clinic (https://www.mayoclinic.org/search/search-results?q=alcohol%20and%20aging).
Centers for Disease Control and Prevention (https://www.cdc.gov/mmwr/preview/mmwrhtml/00001403.htm)
The Constitutional Foundations
By John Turley
On August 27, 2025
In Commentary, History, Politics
Who Controls Elections?
Donald Trump has repeatedly claimed that the president should have broad authority to change how elections are conducted—particularly when it comes to abolishing mail-in voting and voting machines. As recently as August 2025, Trump pledged to issue an executive order banning mail-in ballots and voting machines ahead of the 2026 midterm elections, insisting that states must comply with his directive because, in his words, “States act merely as ‘agents’ for the Federal Government when it comes to counting and tabulating votes.… They are required to follow what the Federal Government, represented by the President of the United States, instructs them to do, FOR THE GOOD OF OUR COUNTRY”.
But this isn’t the first time he has suggested that he could control the election process. In March 2025, Trump issued a major executive order titled “Preserving and Protecting the Integrity of American Elections” that aims to expand presidential control over the election process. The order attempts to direct the Election Assistance Commission (EAC) — an independent, bipartisan agency — to mandate that voters show a passport or other similar document proving citizenship when registering to vote using the federal voter registration form. The executive order has been the subject of extensive litigation, and several federal judges have issued injunctions against various portions of it.
Amid the COVID-19 pandemic during his first term, President Trump publicly suggested delaying the election. Constitutional scholars and members of Congress quickly pointed out he lacked such authority—the date of federal elections is set by statute, and only Congress could change it.
The U.S. Constitution provides a clear framework for who holds the authority to control elections, and it is not the president.
Article I, Section 4: Congressional and State Authority
The main constitutional authority over U.S. elections is found in Article I, Section 4, commonly called the “Elections Clause.” It states:
“The Times, Places and Manner of holding Elections for Senators and Representatives, shall be prescribed in each State by the Legislature thereof; but the Congress may at any time by Law make or alter such Regulations…”
This language charges state legislatures with defining the details of congressional elections, including logistics and procedures. Importantly, Congress retains the power to override state laws and impose federal rules—such as standardized Election Days or regulations for voter registration and districting.
What does this mean for the president? The Constitution is clear: the president has no direct authority to determine the conduct of congressional elections or to unilaterally change the way federal elections are held. Presidential influence over elections is limited to signing or vetoing congressional legislation, not acting alone.
Article II and the 12th Amendment: Presidential Elections
Presidential elections are regulated by Article II, which created the Electoral College, and by the 12th Amendment .
Article II, Section 1 provides:
“Each State shall appoint, in such Manner as the Legislature thereof may direct, a Number of Electors…”
States arrange how their presidential electors are selected, subject to changes imposed by congressional law. The federal government, through Congress (not the president!), determines the timing of choosing electors and casting electoral votes. The 12th Amendment sets procedures for how electors meet and vote for both president and vice president.
Again, neither Article II nor the 12th Amendment gives the president authority to independently set election rules. At most, the president can recommend reforms, sign laws crafted by Congress, and advocate for certain policies.
Historical Examples of Limits on Presidential Power Over Elections
Even during national crises, presidents have not been able to unilaterally change election rules:
Presidential Powers: What Can the Executive Branch Do?
The president’s responsibilities in elections are more limited than you might expect and are essentially ministerial and ceremonial, not regulatory.
The executive power in Article II invests the president with broad national leadership, command of the military, and responsibility to “take Care that the Laws be faithfully executed”. This can include enforcing voting rights laws and overseeing federal agencies that support election integrity. However, the Constitution and decades of legal precedent restrict the president from directly controlling election rules.
When presidents have sought to influence election administration more directly, courts and Congress have reaffirmed the constitutional boundaries. For example, efforts to change the date of an election or prohibit certain voting methods without congressional action have consistently failed in the courts.
Congressional Power: The Real Check on Election Rules
While state legislatures remain the primary manager of elections, Congress retains the final word. The Supreme Court has confirmed that congressional law “preempts” conflicting state rules in matters of federal elections. When Congress acts—through laws like the Voting Rights Act, Help America Vote Act, and the National Voter Registration Act—states must comply, and the president’s role is simply to sign or veto those laws.
Congress has used its power over the years to:
Checks, Balances, and Modern Tensions
Recent political debates have seen calls for presidents to take stronger action on election oversight, especially regarding the use of mail-in ballots or voting machines. However, these calls run up against clear constitutional limits: the president cannot rewrite the rules of elections without Congress or state legislatures.
Any presidential attempt to do so by executive order would face swift legal challenges and almost certainly be invalidated. The intent of the Framers was to divide election power between the states and Congress, with the president largely excluded from direct rule-making authority. This balance—central to federalism—protects elections from potential abuses of executive power and ensures that reforms require broad democratic consensus. While presidents can champion reforms and enforce federal laws supporting fair elections, they are constitutionally forbidden from unilaterally changing election rules.
Conclusion
The framework isn’t perfect—it can create confusion when state and federal authorities clash. But the basic principle remains: states run elections. Congress can regulate them within constitutional bounds, and presidents enforce the resulting laws.
For citizens, lawmakers, and presidents alike, respect for these boundaries secures the foundation of American democracy. The right to vote—and the integrity of how that vote is counted—is protected not by any single leader, but by enduring constitutional principles and the shared power of states and Congress.