Alcohol & Drug Abuse Among the ElderlyThe misuse of alcohol and other drugs has always been thought to be a problem for young people, but such problems have no age limits. We used to believe that older people “aged out” of drinking too much or using illicit drugs. However, current information does not fully support these beliefs, which may come as a surprise to family members caring for a parent who may live at home or in an assisted living facility. It’s not clear whether abuse of alcohol and other drugs in older adults represents a pattern of continued use, a return to use after a period of abstinence, new onset of use, or a combination of each of these patterns.

As productive adults age and move into their ‘retirement’ years, many life changes occur. For instance, stressful late-life events, loss of productive social roles, loneliness and the absence of supportive social relationships, to name a few, can lead to depression which may go undiagnosed for years. Older adults may drink more to cope with these feelings. Additionally, drinking habits acquired in early life continue to be maintained through the life span.

One point that has been demonstrated in recent research studies is that older people use and misuse a variety of substances. For instance, a vast majority of the elderly take prescribed medications (sometimes not as prescribed) for physical and psychiatric ailments. They buy over-the-counter medications (which they may not always take according to instructions or report their use to a primary health provider); they drink alcohol, smoke cigarettes, and use illicit drugs such as marijuana.

The misuse of prescribed or over-the-counter drugs may involve:

  • deliberately using higher than recommended doses,
  • using them for extended periods,
  • hoarding medications and
  • using medications together with alcohol

Studies also show that there is a growing number of elderly using heroin and cocaine. Another problematic use of prescribed medications involves “borrowing” a medication from a friend or relative instead of seeking medical advice. The primary problem here is that all medications and drugs of abuse may (and generally do) interact with each other producing toxicity, cause withdrawal symptoms, cause and physical and/or psychological harm after short or long-term use. In the end, there are further adverse effects which usually cause the person to take even more medication to neutralize these nasty side effects.

We, as a society, tend to ignore, rationalize or minimize the effects of alcohol on the elderly. Whenever we witness forgetfulness, depression, an unsteady gait, and the like, we tend to blame the aging process rather than examine the possibility of an alcohol or other drug problem. A myth found in the medical community is the mistaken opinion that the ‘window of risk’ of developing alcohol problems is closed by age 50. Primary health care providers won’t often discuss the use of alcohol or other illicit drugs with their patients, creating a veil of secrecy that both parties agree to.

How Much is Too Much?
Alcohol is by far the most common substance abuse problem in older adults. Approximately half of American adults aged 65 and over drink alcohol regularly and estimates of late onset alcoholism have been reported as high as 68%.

Experts suggest that levels of alcohol consumption identified as safe for the average adult may constitute a higher risk for seniors. Among current drinkers aged 60 or more, up to 30% of men and 15% of women consume alcohol in excess of recommended guidelines. Although definitions are not well-standardized, heavy drinking is considered consuming an average of two drinks per day for men and one drink per day for women. Binge drinking usually corresponds to more than four drinks on a single occasion for men or more than three drinks for women within two hours. And studies examining what the safe levels of drinking are for older adults who are taking prescription and/or over-the-counter medications have yet to be conducted.

It has been reported that as many as one-half of all nursing home residents have alcohol-related problems. However, in recognition that alcohol consumption is a normal part of adult social life in the U.S., some nursing homes provide cocktail hours as an opportunity for social interaction among residents, with the belief that alcohol serves as an aid to sociability. However, we believe that some of these residential programs may unwittingly worsen alcohol problems for some residents through well-intentioned policies and programs that provide opportunities, if not encouragement, for alcohol consumption.

Already Have Medical Problems?
The identification of alcohol consumption as a problematic behavior is especially important for older drinkers. Even when consumption patterns may not suggest an addictive disorder, older people can experience substantial health risks. Aging is also often associated with an increasing risk of painful medical conditions. Various substances (including alcohol) are used to cope with pain. Moreover, older adults with substance use problems and who use alcohol or drugs to manage pain have poorer health outcomes.

According to the National Advisory Council on Aging, “although most seniors enjoy good mental health, as many as 20% of people age 65 and over suffer from mild to severe depression. Alcohol is often used to resolve these feelings. Initially, it works but ultimately, the alcohol worsens the depression. Older people who are depressed are three to four times more likely to have alcohol related problems than older people who are not depressed. A common sign of depression is emotional responses that are sometimes are expressed by people as “I don’t know [how I feel], I don’t care. Leave me alone,” and with the person “shutting down.”

Conclusions
Given the propensity of drug abuse in the baby boomer generation, it is expected that, as they age, the incidence of drug abuse will also increase. Substance abuse among older people is often missed or misdiagnosed, and many such problems may be confused with other difficulties of aging and are thus ignored. It is always important to tell your primary care provider if you are using alcohol or other substances and how much as it could conflict with any medications you are taking or may take in the future. Believe it or not, getting the support and treatment needed will surely improve the quality of life.

If you believe your loved one could have an undiagnosed substance use problem, first, talk to him or her about your concerns and give examples of your observations. Tell him or her that you are concerned about the potential effects down the road and how much you want him/her to be as healthy as possible. Also, suggest that he/she speak to the primary healthcare provider about this. By all means, remain supportive and consistent.

- William J. Lorman, PhD, MSN
Vice President & Chief Clinical Officer,
Livengrin Foundation, Inc.
Bensalem, PA 19020