The Hazards of Alcoholism in the Elderly

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Millions of people consume alcohol, but each person has their own unique relationship with this substance. While many are able to drink in moderation without it negatively impacting their health, relationships and careers, alcohol use can become problematic for some individuals. Alcohol has a particularly strong impact on seniors, even when consumed infrequently.

Age-related changes in the body, chronic health conditions, prescription medications and other factors can magnify the effects of alcohol consumption and jeopardize a senior’s health. This can cause an older adult’s relationship with alcohol to change even though they may not have altered their drinking habits. Unhealthy drinking patterns like binge drinking and heavy alcohol use are associated with serious health risks, especially for the elderly.

Alcoholism in seniors is commonly overlooked or misdiagnosed by health care providers. Therefore, it is crucial for family caregivers to be aware of the signs of alcohol abuse in older adults. While dealing with an elderly alcoholic parent can be extremely challenging, it is important to understand that treatment programs can be successful.

My Experience Caring for an Elderly Alcoholic

My neighbor Joe was rarely without a hip flask during Prohibition. While this accessory eventually went out of vogue, he didn’t change his drinking habits as he aged. Joe was a functioning alcoholic; he and everyone who knew him were well aware of that fact. But Joe was also a brilliant, inventive and funny man. By the time I had started caring for him, he was 87 years old and had no desire to quit drinking. His wife had died a few years before, and his only son lived half-way across the country. I was all he had.

I purchased and set up a medical alert system for Joe, and I was beyond grateful for that device. He would fall often due to his deafness, balance issues, and, of course, his alcohol consumption. When he fell, he’d activate his personal alarm, which would notify a dispatch center, who would then call me to check on him. I’d run next door to his house, and, with the help of a chair and some tugging, peel him up off the floor.

One evening, my phone rang as I was fixing supper. The dispatcher told me Joe had set off his wrist alarm, which was nothing new, but somehow this time felt different. As I walked through Joe’s kitchen door, I saw him lying in pain on the floor with his leg at an unnatural angle. I immediately called 911 and it was just what I’d suspected: a broken hip. The paramedics took Joe to the hospital, where he had surgery to repair his hip and then spent a horrible week there recovering. But, instead of healing and regaining his strength, he spent those miserable days hallucinating and shaking from alcohol withdrawal in addition to the pain of his broken hip.

I visited every day and never once saw any of the doctors or nurses do anything to help Joe through his withdrawal symptoms. I tried talking to them about his drinking habits but was largely ignored. At the end of that week, Joe was ready to be discharged from the hospital but had declined so significantly that he couldn’t return to his home. He moved to a nearby nursing home, where I continued visiting him. I never saw Joe smile again; he died about six weeks later.

While I can’t be certain what it was that killed him, I am certain that alcohol played a significant role in Joe’s demise. Drinking affected his already poor balance and coordination and contributed to his frequent falls. Going cold turkey after drinking regularly for decades caused debilitating withdrawal symptoms on top of an already considerable health setback.

Sadly, Joe’s story isn’t uncommon. Alcoholism affects many older individuals, whether it has been a lifelong problem or become a relatively new dependence. Seniors are notoriously stubborn and most are capable of making their own decisions, so family members and friends are either largely unaware of any substance use issues or they avoid discussing the topic altogether.

Alcohol Abuse Among the Elderly

The fact is that families, friends and health care professionals often overlook their concerns about older people’s drinking. Sometimes the consequences of seniors’ drinking habits are mistaken for other age-related health conditions, such as dementia or depression, but increasing alcohol use deserves special attention. This is particularly important as the number of older Americans is growing rapidly and alcohol use among seniors continues to increase. According to the 2018 National Survey on Drug Use and Health, more than one in 10 seniors report binge drinking (consuming four to five drinks in about 2 hours) during the past month. Furthermore, 1.6 percent of seniors have been diagnosed with an alcohol abuse disorder, although alcoholism is admittedly underreported and untreated in this age group.

There are two main patterns of alcohol dependence: early onset alcoholism (beginning before age 25) and late onset alcoholism (beginning after age 45). Some people—like my neighbor Joe—have been heavy drinkers for many years, while others may develop a drinking problem later in life. Sometimes this is due to major life changes like shifts in employment, new or worsening health issues, or the death of loved ones. Often these events can bring on feelings of intense loneliness, boredom, anxiety and depression.

In fact, depression in older adults often goes hand in hand with alcohol use. One study conducted by researchers at the University of Georgia found that seniors with multiple chronic health conditions (MCCs) and depression were nearly five times as likely to experience problem drinking as older adults with MCCs and no depression. At first, a drink seems to bring relief from stressful situations, but adopting this unhealthy coping mechanism comes with its own serious health risks while hindering the ability to effectively deal with difficult emotions and any underlying mental health issues.

Determining if a Senior Has a Drinking Problem

It’s important to point out that not everyone who drinks regularly is an alcoholic, and not all problem drinkers consume alcohol every day. To complicate matters further, advancing age also affects how the body processes substances like alcohol and medications. This means that the same amount of alcohol can have greater intoxicating effects on a senior compared to a younger individual. Over time, someone whose drinking habits have stayed the same or increased may find that their alcohol tolerance has decreased.

If you notice any of the following behaviors or incidents in an elderly loved one, it may indicate alcohol abuse.

Common Signs of Elderly Alcohol Abuse

  • Drinking to calm their nerves, forget their worries or manage their depression
  • Quickly gulping down drinks
  • Frequently having more than one drink each day (Per the Dietary Guidelines for Americans 2015-2020, moderate drinking is defined as up to one drink per day for women and up to two drinks per day for men. A standard drink consists of 12 ounces of regular beer, five ounces of wine or 1.5 ounces of 80-proof distilled spirits.)
  • Lying about or trying to hide their drinking habits
  • Instances of hurting themselves or someone else while drinking
  • A high tolerance and need more alcohol to “feel” its effects (Alcohol tolerance typically increases over time but declines later in life.)
  • Being irritable, resentful or unreasonable when sober
  • Having medical, social, legal or financial worries caused by drinking
  • Isolating themselves and avoiding activities that do not involve alcohol
  • Showing signs of drunkenness (slurred speech, loss of coordination, smelling of alcohol, etc.)
  • Cognitive decline or unusual changes in memory
  • A decline in self-care, care of their household and/or care of others in their charge (grandchildren, pets, care recipients, etc.)

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How to Address a Senior’s Alcohol Use

Many elders are very clever about hiding their bad habits, so family and physicians can’t always be blamed for not addressing them. In fact, a significant number of people of all ages aren’t forthcoming with their physicians when it comes to talking about less contentious lifestyle factors like medication adherence and exercise habits. Discussing alcohol consumption can be even worse. Many people simply tell their doctor what they think he or she wants to hear. Common fibs include, “I only have a couple of glasses of wine in the evening” and “I only drink at social events.” These little lies can actually jeopardize one’s health, but we’ll talk more about that in a minute.

Family members and friends typically have the most regular and candid interactions with their elders. It often falls on them to monitor loved ones for signs of trouble and initiate conversations about things like excessive drinking. This is easier said than done, though. At best, most family members expect an elder to get defensive, downplay their drinking or make half-serious promises to cut back. Alcohol use is a major point of contention for many families and there is no simple way of handling it, especially if a loved one has an alcohol use disorder. Calm, rational, caring discussions are the best way to go about addressing this matter, but the senior must be willing to participate and reduce their alcohol intake.

In some cases, bringing an elder’s true drinking behavior to their physician’s attention can be beneficial. This strategy works for some families who are trying to address another difficult age-related issue: unsafe driving. Such an approach can be hit or miss—it really depends on the doctor. Some simply aren’t in tune with this problem, and others might be insensitive or even judgmental once they learn the truth. In my opinion, overlooking alcoholism or passing judgment on someone who is struggling with substance use further jeopardizes a patient’s health.

Regardless, notifying doctors of an elder’s alcohol use is especially important in emergency situations like Joe’s. Family members shouldn’t be ashamed to tell medical professionals that an elder has a substance abuse problem, whether is it alcohol, drugs or prescription medications. An understanding doctor can be an excellent ally during an intervention staged to help a senior accept treatment. At least you’ll know you did your part to get your loved one the care they need.

The Health Effects of Alcohol on the Elderly

Even a small amount of alcohol can impair a senior’s judgment, coordination and reaction time. Therefore, drinking increases the risk of work and household accidents like falls and hip fractures, which can be devastating for older adults. Aside from the dangers of intoxication, alcohol use can also exacerbate many medical conditions, such as high blood pressure, ulcers and diabetes.

Furthermore, many prescriptions, over-the-counter (OTC) drugs, dietary supplements and herbal remedies can be dangerous or even deadly when mixed with alcohol. This is a special worry for seniors because nearly 40 percent of people age 65 and older take at least 5 prescription medications. If an aging loved one drinks and takes any medications, ask their doctor or pharmacist if this combination is safe. For example, Aspirin can cause bleeding in the stomach and intestines just on its own. The risk of bleeding is much higher in those who drink alcohol while on this OTC medication.

Heavy drinking over time can cause certain cancers, nutritional deficiencies, cirrhosis of the liver, pancreatitis, immune system disorders and even brain damage. Alcohol can make some medical concerns difficult for doctors to find and treat as well. For example, chronic alcohol use causes changes in the cardiovascular system that can potentially dull the warning pains that occur just before a heart attack. Drinking can also make older people forgetful and confused, which could be mistaken for signs of Alzheimer’s disease or other forms of dementia. Misdiagnosis and mistreatment do not address the true problem and can further endanger a patient’s health.

The physical and mental effects of both short- and long-term alcohol use are extensive, but drinking can take a toll on one’s social life and relationships as well. People who abuse alcohol may be putting themselves at risk for serious conflicts with family, friends and coworkers. The more heavily they drink, the greater the chances are for trouble at home, at work, with friends and even with strangers. This can lead to isolation, depression and a consequent increase in alcohol consumption.

The Benefits of Senior Alcohol Treatment

Studies show that treatment can be just as beneficial for older problem drinkers as younger individuals with alcohol use disorders. An understanding physician can provide advice about health risks, drinking and available treatment options. Local health department and social services agencies can also offer contact information for helpful resources and information on costs and insurance coverage.

There are many types of treatments available. Some, such as 12-step programs, have been around for a very long time. Detoxification, taking prescription medicines to help prevent relapse once a person has stopped drinking, and individual and/or group counseling can all be part of a successful alcohol treatment plan. Age-specific addiction treatment programs may best suit the unique needs of older adults struggling with alcohol use. Newer modalities focus on helping participants identify which situations or feelings trigger the urge to drink and learn alternative coping methods. Because familial support is so important for those in recovery, many programs also include marital and family counseling as parts of the treatment process.

Annual alcohol misuse screening and a series of counseling sessions are covered by Medicare Part B. Medicare also provides at least partial coverage of inpatient and outpatient substance abuse treatment for beneficiaries as long as it is deemed reasonable and necessary. If an aging loved one is a veteran, the Veterans Health Administration offers a number of covered treatment programs for substance use disorders.

The Substance Abuse and Mental Health Services Administration (SAMHSA), an agency within the U.S. Department of Health and Human Services, hosts a free, confidential National Helpline that provides treatment referral and information in English and Spanish for individuals and families facing mental and/or substance use disorders. The SAMHSA National Helpline can be reached 24/7, 365-days-a-year at 1-800-662-HELP (4357).

What to Do When a Senior Refuses to Stop Drinking

Unless a senior is incompetent or poses imminent danger to themselves or others, there is little that family, friends or even their doctor can do about their drinking. Excessive alcohol use is one of the many dangerous choices that competent seniors can make for themselves. An aging loved one may tell you that it is the “only pleasure” they have anymore. For some it is. For some it is simply too late to help. Our options may be limited to providing supportive care or devices, such as a personal alert system, and limiting their access to alcohol.

However, it is important to understand that withdrawal symptoms can be very risky for seniors who are dependent on alcohol, and detoxification should always be managed by a trained medical professional. While sobriety may seem like the ideal outcome for an elderly alcoholic, it may not be reasonable. According to the National Initiative for the Care of the Elderly (NICE), an international group committed to improving the care of seniors, “the end goal of abstinence is not necessary or realistic for many older adults with substance use problems.” NICE advises considering a more realistic goal for treatment and counseling that prioritizes harm reduction and quality of life improvement instead of focusing solely on stopping alcohol use.

After many close calls, accidents and attempts at getting through to a loved one with a drinking problem, it is ultimately up to you how to proceed. Some family members successfully detach from an alcoholic elder without any guilt, some commit to providing support and guidance regardless of how badly they spiral out of control, and others vacillate between these two approaches. Whichever one you decide to take, remember to look after yourself, too. Counseling and attending Families Anonymous and Al-Anon Family Groups meetings can help you better understand and handle your loved one’s struggles with alcohol.

Sources: Introduction to Older Adults and Substance Use (http://www.nicenet.ca/tools-introduction-to-older-adults-and-substance-use); Late Onset Alcoholism (https://pubmed.ncbi.nlm.nih.gov/12763296/); Key Substance Use and Mental Health Indicators in the United States: Results from the 2018 National Survey on Drug Use and Health (https://www.samhsa.gov/data/sites/default/files/cbhsq-reports/NSDUHNationalFindingsReport2018/NSDUHNationalFindingsReport2018.pdf); Problem Drinking and Depression in Older Adults With Multiple Chronic Health Conditions (https://pubmed.ncbi.nlm.nih.gov/27748504/); Polypharmacy Among Adults Aged 65 Years and Older in the United States: 1988–2010 (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4573668/#); Medicare: Alcohol misuse screenings & counseling (https://www.medicare.gov/coverage/alcohol-misuse-screenings-counseling); Medicare Coverage of Substance Abuse Services (https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/SE1604.pdf); Substance use treatment for Veterans (https://www.va.gov/health-care/health-needs-conditions/substance-use-problems/); Facts About Aging and Alcohol (https://www.nia.nih.gov/health/facts-about-aging-and-alcohol)

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