Substance Abuse in the Elderly: Alcohol, Drugs & Treatment

Introduction

Stereotypes of elderly people include the crotchety grandfather, the kindly grandmother, or a gentle older person who tells stories of years gone by. The elderly are associated with concepts such as infirmity, illness, and wisdom. Furthermore, as baby boomers retire, the post-60 years are increasingly being seen as times of continued activity and productivity. More advances are therefore being made to address the diseases that previously plagued those in the post-retirement years.

Not enough attention, however, has been given to a serious problem that is plaguing a growing segment of the elderly population today: substance abuse.

Alcoholism in Older Adults

This paper examines the extent of substance abuse in the elderly. The first part looks at the extent and symptoms of alcohol abuse among the elderly. The second part examines the incidences and symptoms of drug abuse. The third part evaluates different therapy programs and treatment options for elderly substance abusers. The paper concludes by arguing that substance abuse among the elderly is caused by a confluence of reasons, ranging from physical symptoms to neglect, and that it is therefore important for family members and caregivers to recognize and act upon the early symptoms of substance abuse.

Conventional wisdom previously held that the elderly population has lower rates of alcohol use compared with the rest of the population. However, more older adults are now showing alcohol-related problems. These problems include alcohol abuse, milder forms of alcohol dependence, and other medical conditions that are exacerbated by alcohol use. Previous studies have estimated that up to 20% of elderly adults have some form of alcohol-related problem (Ondus et al. 1999).

Benshoff et al. (2003) have noted the difficulty of diagnosing alcohol abuse among the elderly population. While the National Household Survey revealed that the cohort over 65 years old had the lowest alcohol-related problems, these figures could be skewed. The elderly cohort is often a "hidden" population, and its members frequently do not engage in the social behaviors that highlight alcohol use, such as drunk driving. This population is also more likely to view alcohol use as a moral failing, and is therefore less willing to report alcohol problems.

Researchers believe that up to two-thirds of elderly alcohol abusers are "early onset" drinkers — people who began abusing alcohol prior to age 65 and continued their consumption into old age. Because this population has already weathered the rigors of long-term alcoholism, they exhibit significant health and mental complications. Genetics may account for the survival of some individuals in this category, as may a learned ability to moderate consumption over time (Rigler 2000).

In contrast, late-onset abusers who begin drinking after age 65 typically do so in response to a negative life change. Many late-onset alcohol abusers turn to drink after the death of a spouse. Other triggering factors include retirement, a perceived decline in community status, and other health setbacks. Compared to early-onset drinkers, however, late-onset drinkers tend to have stronger social connections, which makes diagnosis easier. They have also generally not suffered the physiological damage associated with long-term alcohol abuse (Rigler 2000). Further studies have shown that heavy late-onset drinkers exhibit higher suicide rates, as suicide is often associated with depression.

This distinction affects the signs used for diagnosis and the potential consequences an elderly person may suffer from alcohol abuse. In general, aging results in increased sensitivity and decreased tolerance to alcohol. The rate of alcohol absorption is moderated by body mass, and as a result, older adults may misjudge and overestimate the amount of alcohol they can tolerate. This problem is compounded by the decreased absorption rate in the gastrointestinal system of older adults. Ingested alcohol therefore remains in the body longer and at higher concentrations (Benshoff et al. 2003).

These factors combine to worsen the cumulative effects of alcohol on the aging body. The excretory and nephritic systems are exposed to alcohol for longer periods, leading to illnesses such as cirrhotic liver disease and kidney failure. The rate of cirrhosis of the liver among the elderly population is twice that of the general population (Benshoff et al. 2003). Analysts believe that figures for gastrointestinal diseases could also be affected by alcohol consumption.

There are also secondary health and safety issues associated with alcohol use in older adults. Elderly alcoholics who spend a significant portion of their fixed income on alcohol often neglect other basic needs, leading to malnutrition and poor health. People under the influence of alcohol are also prone to alcohol-related injuries such as slips and falls (Benshoff et al. 2003). Many hospitals and nursing home facilities note that alcohol consumption may be a contributing factor in a growing number of these injuries, particularly as more elderly people choose to live alone.

Given these risks, diagnosing and recognizing the symptoms of alcohol abuse is especially critical in this population. Mersy (2003) notes that a history of DWI convictions and "poorly explained trauma" should raise a caregiver's or primary care physician's suspicions. The American Society of Addiction Medicine (ASAM) recommends that men who consume four or more drinks per occasion or 14 or more drinks per week may have addiction problems; for women, who generally have smaller body masses, the thresholds are three drinks per occasion or seven drinks per week. Although these figures may vary further for elderly individuals, they provide a useful starting point for evaluating drinking issues.

Other screenings can identify early signs of alcoholism. Caregivers and primary care physicians can assess, for example, whether an elderly person has tried to cut down on drinking or uses alcohol as an "eye-opener" in the morning. Expressed guilt about drinking or annoyance at questions regarding alcohol use are further red flags (Mersy 2003).

Blow (2003) notes that many of the criteria normally used to assess drinking problems in the general population do not apply to the elderly. For example, since many elderly people are retired, the criterion of "failure to fulfill major role obligations at work, home, or school" carries less diagnostic weight. However, an alert caregiver can recognize emotional withdrawal and secondary symptoms such as unexplained injuries from falls.

In summary, recognizing the symptoms of alcohol abuse among the elderly is a challenging task. Nevertheless, the elderly population faces significant physical and mental health risks from alcohol abuse. Compounding the problem, it takes far less alcohol to cause conditions such as cirrhosis, kidney failure, and high blood pressure in older adults. These factors make accurate diagnosis all the more important for this population.

Conclusion

The successful treatment of substance abuse issues among the elderly begins with an honest recognition of the problem. Caregivers and primary care workers must be trained to recognize the symptoms of both alcohol and drug abuse. Successful treatment programs then require careful medical management alongside support from peer groups and loved ones. By taking these steps, society can begin to address this silent epidemic and ensure that older adults receive the care and attention they deserve.