My neighbor Joe was rarely without a hip flask during Prohibition, and, while a hip flask 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, was well aware of that fact. He was also brilliant, inventive and funny. He had reached 87 years, and had no desire to quit drinking. His wife had died a few years before, and, as his neighbor, I'd become his primary caregiver. His one son lived half-way across the country.
During the time I was caring for Joe, I'd set up a personal alarm system, so he would get help if he fell or needed assistance for any reason. He had the necklace variety, and generally wouldn't wear it until I hung it around his neck during my daily visit, generally around the noon hour. Many times I was grateful for that alarm, as Joe would fall often, due to his early deafness and accompanying ear problems, and of course, also due to his alcohol consumption. When he fell, he knew to push the button on his alarm. The alarm would notify a dispatch center and they would call me to check on him. I'd run over, and usually, with the help of a chair and me tugging on him, we'd get him up off the floor.
So, when my phone rang one evening as I was fixing supper, and the dispatcher told me Joe had set off his wrist alarm, it was nothing new. The sun was low and cold as I ran across our snowy yards and through his doorway. I'd just left him a few hours before, and had monitored his lights as he went about his house in the dusky afternoon. That was one way I'd keep tabs on him. I knew his habits. I'd noticed he had started his supper, and then I didn't see him, but generally he'd watch TV for awhile before he ate.
This time felt different, even before I pushed through his doorway. When I saw him, he was lying on his kitchen floor with his leg at an unnatural angle. I grabbed my ever present clipboard and wrote to him that I was calling 911. Joe and I communicated through my writing and his speaking, since his deafness was profound. He resisted and tried to move, then lay back in agony, and let me call for an ambulance.
It was what I'd suspected - a broken hip. The break that traumatizes the body to such an extent that many elders soon die, even if the hip has healed. The medics took him into surgery to repair the hip and then Joe spent a horrible week in the hospital, hallucinating and shaking from withdrawal in addition to the expected pain of the broken hip.
I visited every day. He told me of the horrible dreams he was having. He was shaking and obviously going through alcohol withdrawal. If the doctors had a clue, they didn't show it. Surely, it was obvious on his admitting records that he had a great deal of alcohol in his system. I tried talking to them, but was basically ignored. Was he unworthy of compassion because he had been drinking when he fell?
They did nothing that I could see, to help Joe through the withdrawal. They said he had enough medication, and that he was "an alcoholic, you know." Well, uh, yes. That was my point. He was going through withdrawal along with all of his other pain. In this modern society of medicine as we know it, couldn't they help him?
Joe struggled through a hellish week, and then – since he couldn't go home alone – I found him a room at a nursing home near my home, so I could keep visiting every day. I never saw Joe smile again and he was dead within six weeks. Was it the broken hip or alcohol withdrawal? Likely, it was a combination of the two.
I'd like to think things are different now, but I'm not too sure. First, most doctors aren't thinking of a "little old man or little old lady" and alcoholism in the same context. Yet we have many elders who, like Joe, were heavy drinkers their entire lives, or some who just began to drink excessively after retirement or after the death of a spouse. We have many elders addicted to drugs, prescribed and otherwise. And our Vietnam veterans are aging. Many of that generation have alcohol and drug problems that have not been treated. We will see more and more elders who need attention to this medical problem.
Yet, when I am contacted by frantic families about their alcoholic parent or grandparent, they say that, other than a few studies, the only place they find any real honesty about the subject is my writing. While I'm happy to help them with suggestions to contact the Veteran's Administration, if the elder is a veteran, and organizations such as Families Anonymous and Al-Anon, I am always amazed at how clueless the physicians that are dealing with these elders are. The stories people tell me sound like they come from the dark ages. Doctors seem to be overlooking alcohol addiction as a possible reason for health problems, falls and even dementia. Some who find it are less than compassionate. Judgment clouds their delivery of good medicine.
An elder who is in withdrawal, yet going through emergency surgery, is in trouble. An elder who is showing signs of dementia may be diagnosed with Alzheimer's or another dementia by his or her general physician, when the elder is suffering from alcohol-induced dementia. Many elders are very clever about hiding their addictions, so family and physicians can't always be blamed for not addressing it. However, physicians need to be on the lookout, as it is more common than many believe.
And when family members beg for help, physicians need to be armed with information on how to treat an addicted elder. This is not a time for judgment. This is not a time for preaching. This is a medical emergency that needs to be treated as such – with compassion and likely, medication. This is an illness that is destroying the last years of many elders. They will tell you that it is their "only pleasure." And for some it is. For some it is too late to help them. Compassion in treating the symptoms, or controlling the alcohol or drug amounts to keep them from falling, are often the only choices. Desperate families shouldn't be left begging for compassionate care for their addicted elder.
Addiction in elders needs to be on the checklist, right along with high cholesterol and blood pressure. It is, of course, easier to hide. Like smoking, alcohol or drug use questions will generally bring the answer they think the doctor wants to hear. "I only have a couple in the evening." "I only drink at social events." "I only have wine at communion."
A chat with a family member (with the elder not present) could be very enlightening. That charming little grey-haired lady with the disarming smile may be a full-blown alcoholic. The dignified 58-year-old business man with the memory lapses may be a heavy marijuana user. Family members may have tried for years to help their elder, to no avail. Doctors may not be able to help them "sober up," either. But they can help them through emergencies, if they are aware of the signs. Families shouldn't be ashamed to tell doctors that their elder has a substance abuse problem. And doctors need to practice compassion in dealing with the families and the addicted elder. If this doesn't happen, there will be a lot more Joes. People can die a miserable death from untreated withdrawal, when medical intervention could have made them comfortable, or even saved them. Awareness here, as with most issues, is key.