Jennifer Axelson, LCSW, CCM, MSCC, CLCP
Happy Hour at an assisted living community tends to be lively, well-attended and a very welcome diversion from the day-to-day routine. In a building filled with adults who have less responsibility than they once did, and who rarely drive or leave the property, having a glass of wine or two is an innocent proposition.
Unless, of course, it’s not. Some seniors come to their retirement years with a history of heavy drinking and absolutely no plans to give it up. Still others are described as “late onset” alcoholics, older people with no prior history of alcohol abuse who come to rely on drinking to assuage negative emotions and other issues that appear in the later years.
Relationships with alcoholics almost always come with a distinct set of rules, the most important of which is not to talk about it. As both advocates and family members, this is one rule we should break.
Alcohol and The Senior
Whether the penchant for drinking is long-standing or relatively new, it’s important to recognize that alcohol impacts seniors a little differently than it does younger users. Unlike their younger counterparts, older drinkers must consider unique possibilities:
- Harmful interactions with prescription or over-the-counter medications may occur. Most people over the age of 65 are taking at least two prescription medications;
- Tolerance for alcohol diminishes with age so the two or three drinks they once took in stride could now cause significant impairment;
- Diabetes, malnutrition and osteoporosis are all aggravated by alcohol.
Many families seem reluctant to disrupt long-standing drinking habits, mainly because the drinker has “always done it”, and because it seems a little cruel to separate grandma from her evening drinks at a time in her life when she may have little else to enjoy. Intervention is not for every family/client. If grandma is competent and does not drink and drive, she retains the ability to make poor decisions, which can include consuming alcohol even when others prefer that she not do it. Apprise her of the risks and of your wishes that she cut down or stop.
If a client or loved one is unlikely to quit drinking, advocates and family members should proactively inform treating physicians and pharmacists, at the very least. Sooner or later, the elderly client will experience some form of medical reversal that could involve hospitalization and days or weeks away from alcohol. Recovery from any setback can only be complicated by symptoms of withdrawal. The doctor should be aware when prescribing medication or undertaking a surgery/procedure that the patient is a heavy drinker – this information could change the treatment protocol.
Pharmacists should be made aware of alcohol use so they can be alert to potentially problematic prescriptions. If a different class of drug might address the same medical issue with fewer negative alcohol-related side effects, the pharmacist can consult with the treating physician about the risks and benefits of a change.
Alcoholism that sets in after the age of 65 is especially confounding because, for the most part, no one is looking for it or especially attuned to its arrival. Medical providers may not even ask about alcohol consumption in a patient they’ve known for 20 years who has never reported a drinking habit. Family members may have no idea this change has occurred. Late-onset alcoholics are unlikely to talk about their newfound coping mechanism and may well keep it hidden without much effort.
The suspected causes of late-onset alcoholism generally appear to revolve around depression, loneliness, boredom and grief. Without the ongoing and relatively consuming distractions of work, seniors may find themselves with hours of idle time characterized by worry, restlessness or acutely-felt social isolation. Having a drink or two may be discovered as a comfort in a difficult time, and a way to medicate away the problems at hand.
Signs that a client or loved on may be using alcohol to address other problems can include:
- 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 themselves
- 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
If the use of alcohol is relatively new, there may be an opportunity to intervene by solving the underlying problem. If social isolation and boredom are at the core of this newfound interest in drinking, efforts can be directed at increased socialization and the identification of former hobbies or interests that the client lacks the initiative to start again themselves. If depression is suspected, talk to the primary care physician about screening and treatment. When grief is the culprit, or drinking may result from the rigors of caring for a spouse with dementia, locate a support group where some of these issues can be talked about and worked through.
Alcohol issues among seniors exist, no matter how well hidden they may be. Each situation is unique, of course, and as service providers and family members, we need to be aware of the problem and consider any steps we can take to prevent a drinking-related disaster in the life of a senior. Driving while intoxicated is an especially concerning possibility.
Bringing the issue into the open is an excellent place to start. Identify the problem and talk about it. Involve the doctor and the pharmacist. Many addictions begin as an attempt to solve another problem (boredom, depression, loneliness) – resolving that core problem in another way might forestall the larger predicament of alcoholism.
© Lifecare Innovations