By Stephanie Williams, LCSW, ACSW
|Seniors and Problem Drinking||Mrs. Carlson|
|How Many Are Too Many Drinks?||Receiving Treatment|
|Alcohol’s Effect on the Body|
Mrs. Jones, age 76, is unsteady on her feet, has tremors in her hands and is malnourished. She is also forgetful, often disoriented and has difficulty staying on track in a conversation. What do you think her problem is? A variety of medical illnesses come to mind, as well and depression and dementia. What might you think about Mrs. Jones if she were 42-years old and had the same symptoms? If you are like most people, the possibility of an alcohol problem would occur to you in the latter case but not in the former.
The good news is that 60 percent of older people in this country drink very little or not at all. The proportion of people over 65 who have a drinking problem is approximately 10 percent. However, among older people who have chronic health problems or are often seen in medical and health care facilities, the proportion is closer to 50 percent!
It is also true that most cases of alcoholism are overlooked by primary care doctors, regardless of the patient’s age. This is particularly likely with older patients. Doctors have little time to ask specific questions that would tease out an alcohol problem, and a senior is unlikely to volunteer the information. Older people may not realize they are drinking too much for their age, or they may be ashamed to bring it up.
Older adults don’t metabolize alcohol and other substances as quickly as younger people. Generally, an at risk older drinker is someone who drinks over one to two drinks per day or more than seven to fourteen drinks per week. That is one drink per day for an older woman, and two drinks per day for an older man, recognizing the differences in male and female bodies. And a senior who consumes four or more drinks in 24 hours is biologically in real trouble. One can of beer, one glass of wine, a single shot of spirits or a small glass of sherry: these all equal one drink.
Alcohol is a toxic substance that adversely affects every organ in its path. It damages not only the liver, but the kidneys, the intestines, the stomach, the throat, the mouth and the brain. Problem drinkers increase their risk for Alzheimer’s disease and other forms of dementia. Additionally, alcohol causes loss of calcium and contributes to osteoporosis (the bone disease), and it impairs the body’s immune system which helps fight off disease. Weight loss, malnutrition, dehydration, metabolic imbalances, insomnia and insensitivity to pain are common side effects of drinking.
Meet Mr. Collins. He is a retired construction worker and lives alone in a downtown apartment. He spends his time watching tv and playing pool or just hanging out with a couple of buddies. Married and divorced twice, he has little contact with his grown children, and his daughter won’t trust him with her children.
Worried about chest pains, fainting spells and constipation, he finally goes to a doctor. Mr. Collins tells the doctor he had a tough start in life, had a “mean drunk” for a father. Mr. Collins left home at age 17 to join the army, where he spent time in Vietnam, “seeing and doing some pretty bad things.” He also admits he drank and drugged in the army but proudly reports he quit all the drugs himself when he returned to the States.
When asked by the doctor about his drinking now, Mr. Collins says he has cut back a lot over the years, just has a few beers with his pals now and then. He has provided us with a number of red flags for a drinking problem, including family history, past abuse, isolation from family, and medical symptoms.
The good news is that he does not want to “drop dead alone in the apartment”, and he would really like to convince the daughter to let him spend time with his grandchildren. A savvy health care professional could help Mr. Collins make the connection between his drinking and his concerns. He may not know how a six pack of beer every couple of days is hurting him.
Or consider Mrs. Carlson, a sixty-year-old homemaker whose busy husband is still practicing law and traveling out of town to give speeches. For years it has been their custom to have a cocktail or two with dinner each night that he is home.
During the past year, she has had difficulty going to sleep at night and has been taking a sedative prescribed by her doctor. She believes taking the sedative along with a few cocktails is helping her get to sleep. Mrs. Carlson’s problem with alcohol and medication comes to light after she has some elective surgery.
When in the recovery room, she experiences agitation, an elevated pulse and respiration and nearly has a seizure. No one had thought prior to surgery to ask her if she drank regularly. Now she feels embarrassed and humiliated, and her husband and grown children are shocked to discover that her nightly cocktails have made her a problem drinker.
Approximately one-third of older problem drinkers are like Mrs. Carlson who didn’t have an abuse problem earlier in their lives. They generally have good coping skills and good relationships with others, and they are likely to deny or hide the problem. Others are likely to miss it, too.
Once a drinking problem is recognized in an older person, the prognosis for improvement is good, provided the person receives interventions tailored to the needs of older people.
Researchers at the University of Michigan have developed and tested a brief intervention program specifically designed for use with older Americans experiencing a drug or alcohol problem. This approach relies on what is commonly termed motivational interviewing, with an educational slant.
It is important to Focus on a concern for the person’s health and well-being while avoiding the use of accusatory language and labels. It works better to weave questions about alcohol use into a discussion of daily self care, including diet and exercise. The client receives educational materials about the effects of alcohol on the older body and then there is a discussion of the older person’s own goals and how drinking might be a barrier.
For Mr. Collins, that means letting him know that most men his age drink considerably less than he, if at all, and expressing genuine concern for the impact of drinking on his health and his inability to see his grandchildren. He decides not to drink on weekends as a start; as a result of his commitment to his decision, he is soon able to visit the grandchildren on Sundays.
To learn more about alcohol and aging, visit the U. S. Department of Health and Human Services web site at www.csat.samhsa.gov or call 1-800-729-6686 to order free literature. And there is a national hotline to help connect older people experiencing alcohol problems with appropriate treatment providers: 1-800-662-4357.