Alcohol and the Elderly

Older Drinkers' Problems Mostly Undected

Dateline: 11/18/98

Although alcohol and substance abuse is statistically at epidemic proportions among the elderly, it remains for the most part unreported, undiagnosed, or ignored.

The reasons that substance abuse by our senior citizens goes undetected are varied, but most have to do with the fact they are no longer active in mainstream society and there is simply no one around to notice.

They are less likely to get in trouble with the law -- stopped for driving under the influence, having a traffic accident, or causing problems in the community. Therefore they have little contact with the police or the criminal justice system. Since many are retired, there is very little chance their drinking will cause them to lose a job or career.

Basically, nobody notices.

He stops by the club and has only a couple of drinks with his buddies and catches up on the news. But when he goes home he doesn't stop, he drinks more, a lot more. It wasn't always like this. When he was younger he was an occasional "social" drinker, but life changed. He was forced to retire early from his life-long career, and his wife left him. He was lonely, frustrated, and scared. To ease the pain, he turned to the bottle.

Of 86 percent of elderly patients who end up getting treatment for a history of binge drinking, 76 percent began drinking heavily in mid or late life, according to a Canadian study. Women are even more likely to start heavy drinking later in life.

A Growing Problem

Most drinkers who started late are affected by social isolation and physical health problems. Many are affected by grief or loss, and others affected by housing, marital, and mental health problems.

Substance abuse among the elderly is a growing problem for the healthcare industry. Substance abuse-related cases cost more to treat because they require almost 26 percent more hospital staff and other resources than discharges that are unrelated to substance abuse.

Because these substance abuse-related cases tend to be more expensive to treat than the average hospital case, the amount actually paid out by Medicare for substance abuse-related care accounted for 23 percent or nearly one-fourth of the total Medicare payments for hospital care.

He stumbles while carrying out the trash, falls down the stairs, and breaks an arm. At the Emergency Room the doctor asks about his alcohol use. He says he only has a couple with the boys at Happy Hour every afternoon. He lies about the drinking he does alone because he doesn't want to give it up. It has become a friend to him now, the only friend he can count on to be there.

As the Baby Boomer generation moves toward senior citizen status, carrying with it habits and patterns of behavior developed in the 1960's and 1970's, the situation could develop into a healthcare crisis. Already, more than one-third of people over the age of 65 in North America drinks alcohol and 10 percent of them abuse alcohol

Ignoring the Problem

Many times the first indication of a problem is when family or friends visit, or are called due to a fall or other emergency. But even then the problem of alcohol or substance abuse will go undetected by healthcare givers.

Part of the problem is getting doctors to accept that elderly alcoholics exist, according to a report by the American Medical Association. "They may deny that the patient has a drinking problem, or be reluctant to make a diagnosis, because they are uncertain about how to treat the disease or because they question whether treatment is likely to be successful with this age group,'' the report said.

The community and care givers will often turn a blind eye to the problem and accept it as a condition of aging, a reaction to loss or grief, or it's "just the way he is." Many times physicians merely presume their older patients are non-drinkers.

He passes out with a pan of food cooking on the stove. He doesn't hear the smoke alarm, but the neighbors do and call the fire department. He can no longer deny that he has a drinking problem. He agrees to seek help.

The problem can also go undetected, according to the Journal of the American Medical Association, if physicians rely on the standard CAGE Questionnaire, which has proven to be ineffective with elderly abusers.

Proper Diagnosis and Care

The AMA and other groups are encouraging doctors to take a closer look at their older patients to identify substance abuse problems, because treatment for these patients can be highly successful. To do this, the AMA suggests:

• Consider problem drinking as a factor when treating a patient for falls, appetite and memory problems, trouble sleeping, and depression.
• Use open, non-judgmental questions such as "Do you use alcohol?"
• Watch for possible interactions between alcohol and prescription drugs, especially anti-anxiety, barbiturate and sedative medications.

If the problem is properly diagnosed, the AMA says, help is available. It has been discovered that alcohol problems can be successfully treated, even in the later years. Elderly alcoholics tend to respond well to treatment, and stay in programs.

On the advice of a Senior Citizen counselor, he attends his first Alcoholics Anonymous meeting. He hears an old-timer share his story and identifies with it. After the meeting, he goes up and talks with the old-timer who becomes his sponsor. He gets involved with service work, helping others and never takes another drink.