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 set up a personal alarm 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 and they would call me to check on him. I’d run next door to his house, and, with the help of a chair and some tugging, we’d 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 to surgically repair his hip and then he spent a horrible week there in recovery. 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 withdrawals. I tried talking to them 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. Instead, he moved to a nearby nursing home so I could continue visiting him. I never saw Joe smile again and he passed away 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 such 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 issues or avoid addressing it altogether.
Recognizing Drinking Habits is Crucial at Any Age
The fact is that families, friends and health care professionals often overlook their concerns about older people’s drinking. Sometimes seniors’ troubles with alcohol are mistaken for other conditions that happen with age, but increasing alcohol use deserves special attention. Because advancing age affects how the body processes substances, the same amount of alcohol can have greater effects on a person as they get older. Over time, someone whose drinking habits have stayed the same or increased may find that they have a worsening problem.
There are two main patterns of drinking: early and late onset. Some people have been heavy drinkers for many years. But, as with my neighbor Joe, over time the same amount of liquor packs a more powerful punch.
Other people 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 friends or loved ones. Often these life changes can bring loneliness, boredom, anxiety and depression. In fact, depression in older adults often goes hand in hand with alcohol misuse. At first, a drink seems to bring relief from stressful situations, but adopting this unhealthy coping mechanism brings its own serious health risks while hindering the ability to effectively deal with the underlying emotions.
Common Signs of Elderly Alcohol Abuse
Not everyone who drinks regularly has a drinking problem, and, to complicate things further, not all problem drinkers drink every day. If you notice any of the following behaviors or incidents in an elderly loved one, it may indicate alcohol abuse.
- Drinks to calm their nerves, forget their worries or manage their depression.
- Quickly gulps down drinks.
- Frequently has more than one drink a day. (A standard drink is one 12-ounce bottle or can of beer or a wine cooler, one 5-ounce glass of wine, or 1.5 ounces of 80-proof distilled spirits.)
- Lies about or tries to hide their drinking habits.
- Has hurt themselves or someone else while drinking.
- Has a high tolerance and needs more alcohol to “feel” its effects.
- Is irritable, resentful or unreasonable when not drinking.
- Has medical, social or financial worries caused by drinking.
- Increasingly isolates themselves and avoids participating in activities that do not involve alcohol.
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 later.
Family members and friends typically have the most regular and candid interactions with their elders, so it often falls on them to at least initiate the conversation about 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 serious point of contention for many families and there is no simple way of handling it. 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 works for some families who are trying to address another difficult age-related issue: unsafe driving. Such an approach can be hit or miss, though. 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 alcohol use 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. At least you’ll know you did your part to get your loved one the care they need.
Letting an Elder's Drinking Go Overlooked Can Have Serious Health Effects
Even drinking a small amount of alcohol can impair judgment, coordination and reaction time and increase the risk of work and household accidents like falls and hip fractures. Aside from the dangers of intoxication, alcohol use can exacerbate many medical conditions, such as high blood pressure, ulcers and diabetes.
Furthermore, many medicines, including prescriptions, over-the-counter drugs, dietary supplements and herbal remedies, can be dangerous or even deadly when mixed with alcohol. This is a special worry for seniors because the average person over age 65 takes at least two medicines a day. If an aging loved one drinks and takes any medications, ask your 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 also can cause certain cancers, nutritional deficiencies, cirrhosis of the liver, pancreatitis, immune system disorders and even brain damage. Alcohol can make some medical concerns hard for doctors to find and treat as well. For example, alcohol causes changes in the cardiovascular system that can dull warning pains that occur prior to 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 and family lives 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 chance 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.
Treatment Is Beneficial for Older Adults
Studies show that treatment can be just as beneficial for older problem drinkers as younger alcohol abusers. An understanding physician can provide advice about health, drinking and available treatment options. Local health department and social services agencies can also provide contact information for helpful resources and information on costs and coverage. Alcohol misuse screening and counseling sessions are covered by Medicare Part B, and, if the elder is a veteran, the U.S. Department of Veterans Affairs (VA) offers a number of programs for those struggling with limiting alcohol.
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. Newer programs focus on helping participants identify which situations or feelings trigger the urge to drink and teaching alternative coping methods that do not involve alcohol. Because familial support is so important for those in recovery, many programs also include marital and family counseling as parts of the treatment process.
When a Senior Refuses to Make Changes
Unfortunately, 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. They 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. Providing supportive care or devices, such as a personal alert system, and limiting their access to alcohol are often the only choices we have.
After many close calls, accidents and attempts at getting through to a loved one with a drinking problem, it’s ultimately up to you how to proceed. Some family members successfully step away from an alcoholic elder without any guilt, some commit to providing support and guidance regardless of how 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 meetings can help you better understand and handle your loved one’s struggles with alcohol.