CONTENTS

Table of Contents
Introduction

1. Overview
2. Alcohol
3. Prescription and Over-the-Counter Medications
4. Barriers to Recognizing Problems
5. Signs and Symptoms of Misuse
6. Talking About Sensitive Issues
7. Assessing a Problem
8. Preventing Misuse
9. Intervention and Treatment

Supplements
Resources

Alcohol, Medication and Older Adults
For Those Who Care About or Care for an Older Adult

Barriers

We may not recognize, assess, or respond to alcohol problems in older people for several reasons.

Attitudes and Beliefs

Attitudes are often one of the greatest barriers to identifying alcohol problems and providing effective treatment to older adults.

Can you think of some examples of beliefs or biases about older people and alcohol use that might be a barrier to recognizing a problem?

Possible responses include:

• Oh, what's the use?

Many people think alcohol problems are untreatable, hopeless, or just plain frustrating, especially in older people. As a result, they choose to hide the problem or remove the individual from a situation, rather than deal with the problem.

• She's not the type!

There is a common stereotype that only men and younger people have problems with alcohol and other drugs. As a result, alcohol problems are often missed or misdiagnosed with older people, especially women.

• What else can we expect from an older adult?

Ageism, negative stereotypes of older people, can work against identifying a drug or alcohol problem. It is easy to explain a behavior as a function of getting old or being old. It is harder to look for a medical, social, or psychological cause.

• Don't rock the boat!

Individuals who have used alcohol for many years incorporate its use into their lives as others might brush their teeth. Family members get used to this behavior and accept it as part of life.

• Not in my family!

Denial is a very common symptom of alcohol and drug use. It may be a conscious or unconscious choice to deny the situation. Some simply lack information on effects of alcohol on health.

Denial can exist on many levels. The individual using alcohol or drugs may not recognize the problems caused by its use. A family member or caregiver may perceive the use of alcohol as a benefit if the older adult appears content or untroubled by the situation. A health care provider may be uninformed of the extent of alcohol use or not assess the full extent of the patient's problems. Cultural and religious beliefs can feed this denial.

Cultural, Language, and Gender Bias

Stereotypes about a particular ethnic group or religion can bias how we interpret what we see. If we believe a particular religious group does not abuse alcohol, we may overlook those people who may be suffering. If we assume alcohol problems due to skin color or income level, we can overlook serious medical and psychiatric causes.

Finding a doctor who is comfortable working with patients from different backgrounds and cultures is important. Knowledge of the patient's belief system helps in interviewing and interpreting responses accurately.

Language can also be a barrier to recognizing alcohol problems. It is helpful to have a family member or interpreter accompany the older adult to doctor's appointments. Critical information can be lost or misunderstood without a common language between the doctor and patient.

Stereotypes about women can cloud judgment about who needs help. Many believe that substance abuse is mainly a problem for men. For older adults, the facts are:

• Women live longer than men.
• Women tend to have less income and insurance coverage than men.
• Women tend to drink alone and not in public.
• Women are more likely to use long-term prescription drugs for depression and anxiety, many of which can be dangerous if taken with alcohol.

Lack of Awareness/Knowledge

It is more difficult to see the consequences of drinking or using drugs in older adults. As people age, retire, slow down, and reduce their responsibilities, changes occur. They may not be driving, may not have to be at work at a particular time, may tire more easily, and may sleep more.

In a younger person, behaviors such as unsafe driving and late arrival at work may trigger a suspicion of substance abuse. In an older person, these behaviors may not be observed.

Many may not be aware that alcohol affects an aging person differently. The consequences are likely to be more severe. Current medical knowledge of these dangers may conflict with cultural or religious beliefs. It is very important to discuss a patient's beliefs with the doctor.

Professional Perspectives

Health care providers may be as slow as anyone else to spot a substance abuse problem. They may be uninformed as to the extent of alcohol use and its effect on the patient and his or her family. Even when a provider suspects substance abuse, it is difficult to diagnose a wide variety of nonspecific symptoms.

Health professionals have their own sets of beliefs and biases and cultural perspectives and stereotypes. Providers may believe that older substance abusers do not benefit from treatment as much as younger patients. There are few treatment programs designed to accommodate the special needs of older adults. Health and social service professionals need specialized training and skills to effectively identify and treat the problems of alcohol use effectively in older adults.

Complicated Diagnostic Factors

Several factors add to the complexity of diagnosing and treating alcohol and drug problems among older adults. Some factors are:

• The overwhelming issues of aging, such as cognitive impairment, sensory loss, and mobility, can easily fill the visit with the physician.
• The close connection between physical health and mental health makes accurate diagnosis difficult.
• The interaction between prescription medications is far more common among older adults.
• Alcohol and drug abuse mimic other conditions commonly seen in older adults.

Some of the conditions that look like alcohol and drug use are:

• Dementia unrelated to alcohol
• Side effects or bad reactions to medication
• Medical conditions common in older adults
• Worsening of an existing chronic illness
• Depression
• Anxiety
• Aging-related changes

Alcohol problems, diseases, complications of aging, and drug interactions can all have similar symptoms, including:

• Dulling of the senses
• Disorientation/confusion
• Recent memory loss
• Slowed thought processes
• Uncoordinated muscles
• Tremors/shaking
• Swelling/inflammation of joints
• Indigestion/gastritis
• High blood pressure
• Depression/anxiety
• Heart disease
• Altered response to stress
• Poor nutrition

Try to determine if the problems you see are due to alcohol and drug misuse or due to other disorders, such as depression. Do not be afraid to talk to the doctor if you suspect a problem with alcohol or other drugs.

The Health Care System

Today's health care system provides many barriers that make it difficult to recognize an alcohol or medication problem. Examples include:

• Inadequate insurance coverage
  Many older adults do not have adequate health insurance to cover the prescriptions ordered by their doctor. Older adults may see alcohol as a more accessible way to reduce pain or depression, either by itself or in conjunction with prescription and over-the-counter drugs.
• Many insurance plans do not cover inpatient treatment for alcohol and drug problems. In addition, few models are available that focus on the unique needs of older adults.
• Shortened patient visits
  Doctor visits are short and hurried. It is unlikely that shorter office visits are sufficient to identify an older adult's underlying problem with alcohol.
• Continuity of care/specialized care
  Many patients do not see the same primary care physician at every visit, making continuity of care more difficult. In addition, many older adults receive care from a variety of specialists, depending on the disease or condition diagnosed.

Shrinking Social Supports

As people age, fewer friends are available for support. Family, friends, and caregivers can support the older adult by driving to appointments, listening as a friend, and preventing the isolation that often comes with aging.

Living alone can put older adults at greater risk for mental health and substance abuse problems. Isolation due to hearing loss or mental confusion can also be risky for older adults.

Communication Challenges

It is always hard to talk to a family member or friend about a sensitive subject like alcohol use. You may not want to risk ruining your friendship or cause the person you care about to get angry or feel hurt. You may feel it is not your business.

Speaking with an older adult can be difficult. Perhaps the individual has some hearing loss. He or she may suffer from chronic pain. He or she could be distracted by the pain or by side effects from pain medication.

An older person could be anxious or worried about something, making him or her unable to focus on your conversation. Maybe the older adult is feeling depressed, thus lacking the motivation to change any behaviors.