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Elderly Alcohol and Substance Abuse
New York State Office of Alcoholism and Substance Abuse Services – OASAS
Alcohol and substance abuse among the elderly is a hidden national epidemic. It is believed that about 10% of this country’s population abuses alcohol, but surveys revealed that as many as 17% of the over-65 adults have an alcohol-abuse problem. In his work at the University of Kentucky, Dr. Hays found that 2.5 million older adults and 21% of older hospital patients had alcohol-related problems. (Hays, L. et al. Presented at a symposium for the American Academy of Addiction Psychiatry 2002 Symposium: Substance Use Disorders in the Elderly: Prevalence, Special Considerations and Treatment.)
Elderly alcohol abusers can be divided into two general types: the "hardy survivors," those who have been abusing alcohol for many years and have reached 65, and the "late onset" group, those who begin abusing alcohol later in life. The latter group’s alcohol abuse is often triggered by changes in life such as: retirement, death or separation from a family member, a friend or a pet, health concerns, reduced income, impairment of sleep and/or familial conflict. Because alcohol has a higher absorption rate in the elderly, much like it does in women, the same amount of alcohol produces higher blood alcohol levels, causing a greater degree of intoxication than the same amount of alcohol would cause in younger male drinkers.
Alcohol abuse in this generation is complicated by the use of prescription and over-the-counter (OTC) medications. The elderly spend over $500 million yearly on medications. Combining medications and alcohol frequently result in significant adverse reactions. Due to a reduction in blood flow to the liver and kidneys in the elderly, there can be a 50% decrease in the rate of metabolism of some medications, especially benzodiazepines. Additionally, chlordiazepoxide (Librium?) and diazepam (Valium?) have such long half lives (often several days) in the elderly that prolonged sedation from these drugs, combined with the sedative effects of alcohol, can increase the risk of falls and fractures. The benzodiazepine user may become confused and take extra doses or other medications, causing overdose or death.
Serious consequences can result solely from OTC medication use, as well as combining them with alcohol. Laxatives, for example, can cause chronic diarrhea, which can lead to sodium and potassium imbalance and cause heart rhythm irregularities. Antihistamines, another popular OTC medication, can cause confusion; cold medications can elevate the blood pressure and lead to strokes. Caffeine is frequently added to OTC medications and can cause anxiety and insomnia. Often, mixing alcohol and the OTC medications increases the occurrence of side effects and can intensify negative consequences.
Nicotine dependence is also a significant problem in the elderly, due both to their addiction and boredom. Use early in life sets the stage for morbidity and mortality from this addiction. Over 400,000 people in the U.S. die each year from smoking-related diseases. Elderly smokers not only continue to impair their respiratory systems, but are also more apt to die from respiratory diseases. Nicotine replacement products work successfully in this group, especially when combined with behavioral, supportive and other therapies.
WHAT TO LOOK FOR?
The problem of elderly substance abuse may be difficult to detect when the elderly live alone. Friends and family may be reluctant to even consider that there may be a problem and medical evaluations often do not reveal substance abuse. Consideration should be given to the presence of a drug and/or alcohol problem if there is memory loss, depression, repetitive falls and injuries, legal problems, chronic diarrhea, labile moods, malnutrition and recent isolation. Elderly women are more likely to have a diagnosed or undiagnosed depression. According to Dr. Hays, prescription drugs, particularly benzodiazepines, may be abused by these women.
The Center for Substance Abuse Treatment published a list of signals that may indicate an alcohol or medication - related problem in the elderly:
- Memory trouble after having a drink or taking a medication
- Loss of coordination ( walking unsteadily, frequent falls)
- Changes in sleeping habits
- Unexplained bruises
- Being unsure of yourself
- Irritability, sadness, depression
- Unexplained chronic pain
- Changes in eating habits
- Wanting to stay alone much of the time
- Failing to bathe or keep clean
- Having trouble concentrating
- Difficulty staying in touch with family or friends
- Lack of interest in usual activities
