The all so common assumption that alcohol use and abuse is only by teenagers is just that, an assumption. A study by the American Medical Association revealed that over the past 10 years drinking has increased in every age, but those over the age of 65 had the greatest increase of any age group. Numerous studies on the effects of alcohol consumption in seniors indicate that moderate drinking by healthy seniors can have a positive impact on their general health, as many say “one for the road”. For healthy senior adults, moderate drinking is considered to be one-half to one ounce of pure alcohol per day which in the United States of America equates to one 12-ounce beer, 5 ounces of wine, 1.5 ounces of distilled spirits or 8 ounces of malt liquor.
These amounts may, however, decrease the older a person gets due to age-related physical changes that significantly affect the way an older person metabolizes alcohol. These amounts may also be lower for women. Vis-a-vis complete abstinence, this moderate intake has shown to protect against cognitive decline and dementia, protect the vascular system and also increase bone density in women.
On the other hand, there is also a concern that heavy drinking can have adverse effects, and that alcohol abuse is often missed in the senior population. For seniors who are dealing with illnesses or chronic conditions, or who may be taking medication, any amount of alcohol may cause serious health issues or even death. Bearing in mind these factors, it is imperative for the seniors to be aware of their alcohol consumption and for those around them to be able to identify when alcohol consumption has crossed into alcohol abuse.
What causes alcohol abuse in seniors?
There are a variety of factors that can contribute to alcohol abuse in seniors. As a person ages, they may face major life changes such as deteriorating health and financial difficulties. Other situations that may lead to alcohol abuse in seniors include:
- Boredom from retirement or lack of socialization
- Loneliness when children grow and move away
- Loss of friendships due to health complications or death
- Deteriorating health conditions
- Traumatic events like the death of a spouse or illness
Warning are the signs of alcohol abuse among seniors?
Many older people drink occasionally, but as they age, they are more likely to drink even more to relieve the symptoms of physical or mental conditions. It can, therefore, be challenging to tell when a senior’s drinking has become a problem. Friends and family need to be alert and on the lookout for some of the signs which include;
- Intoxication is the first step in the process of alcohol abuse. During a state of intoxication, the senior usually exhibit signs such as emotional instability, slurred speech, blacking out, and nausea.
- Binge drinking. Binge drinking can be described as taking 5 drinks for men, and 4 drinks for women within 2 hours. This is one of the most dangerous drinking behaviors and although previously associated with college teenagers, this has now become a major concern with seniors in society. Binge drinking gets participants more intoxicated faster and can rapidly lead to alcohol poisoning and even death in severe cases.
- An attachment to drinking. When a senior is consumed with the preoccupation to drink and thus becomes a critical part of their identity, then this is a tell-tell sign of alcohol abuse. They develop an extensive routine and ritual around their drinking, such most of their lives are dominated by drinking.
- Inability to stop or cut back on drinking. One of the most telling signs of alcohol abuse in seniors is the inability of them to reduce their consumption of alcohol. One may say they are taking one bottle of beer but instead end up taking several bottles and in a frequent manner without limitation. The urge to keep on drinking increases more often than not, without them necessarily realizing it
- Secretly drinking alcohol. As a way to avoid social stigma or other negative consequences of drinking, the seniors often secretly drink. They generally do so to avoid conflict because they know their loved ones are concerned about their drinking due to the inappropriate frequency and amounts consumed.
- Drinking to feel relaxed. For seniors who have relied on alcohol for self-medication purposes, they often find themselves highly stressed and unhappy when they don’t drink, even when there is no reason to be. At this point, they have come to depend on taking alcohol to “feel better” even though in the long run the alcohol makes them feel emotionally worse than before.
- Excuses or lying about alcohol consumption. Seniors are aware that society regards their actions with concern. They would therefore lie or give excuses about their drinking because they are aware that their drinking has negatively impacted their own lives and even those of their family members and that others either judge or are worried about them.
- High tolerance for alcohol. You develop alcohol tolerance when the body becomes used to the presence of alcohol in its system. The person, therefore, drinks more and more alcohol to get the same effects as before. This increase in the frequency of consumption of alcohol results in alcohol abuse.
Early-onset versus late-onset drinking problem
Alcohol use declines with increasing age for most adults, according to Temple and Leimo, 1989; Fillmore, 1987, although some adults begin to experience alcohol-related problems at or after the age of 55 or 60. Early-onset drinkers have long-standing alcohol-related problems that begin before age 40, most often in their 20s and 30s. On the flip side, late-onset drinkers generally experience their first alcohol-related problems after the age of 40 or 50. Both the early and late-onset problem drinkers use alcohol almost daily as a self-medicating measure in response to losses, hurts and affective changes rather than as a socializing agent.
Early-onset alcohol abusers throughout their lives have turned to alcohol to cope with a range of psychosocial or medical problems. This category comprises the majority of senior patients receiving treatment for alcohol abuse.
Late-onset drinkers are psychologically and physically healthier compared to the early onset drinkers. Since they appear too “normal” they do not raise suspicion easily about alcohol abuse and thus health care providers, as well as family, tend to overlook their alcohol abuse. The late-onset drinkers begin or increase their drinking in response to recent losses such as divorce, change in health status, death of a spouse and retirement.
Dangers associated with alcohol abuse in seniors
Alcohol abuse in seniors is associated with increased health risks. These risks result from lifelong alcohol abuse and even heavy drinking that begins late in life. Some of the dangers associated with alcohol abuse in seniors are;
- Liver diseases. Liver diseases are the most well known medical problems associated with heavy drinking. These diseases include fatty liver, cirrhosis, and hepatitis. These diseases interfere with the vital metabolic processes necessary for good health. The problem of alcohol-related liver diseases increases with age.
- Heart problems. Alcohol abuse frequently increases blood pressure. Also, alcohol consumption is responsible for a temporary heart condition known as a “holiday heart syndrome” which is characterized by an irregular heart rhythm that occurs following an alcohol binge. This increases the risk of a senior having a stroke and cardiac-related deaths.
- Sexual dysfunction. Although many men retain normal capabilities for sexual function well into their late adulthood, senior male chronic drinkers are prone to impotence because alcohol affects normal testosterone production.
- According to a study by Fingerhood, 2000, the risk for cancer increases with abuse of alcohol. Cancer of the larynx, esophagus, colon, including risks for breast cancer in women, are likely results from alcohol abuse.
- Injury from falls. Alcohol abuse leads to an imbalance and impaired judgment by the seniors. In addition to age-related changes in bone density and decreased muscular strength, injury from falls are a common occurrence among alcohol abusers. Some injuries can be serious to the extent of even causing death.
- Nutritional deficiencies. Malnutrition and vitamin deficiencies are common in heavy drinkers. At times the alcohol abusers neglect to prepare a meal or are just unaware that they should do so due to memory loss.
- Psychiatric conditions. Depression is by far the most common disorder associated with alcohol abuse in seniors. Anxiety disorder is also a psychiatric condition resulting from alcohol abuse. Older people, in general, have a high suicide rate compared to other age groups and therefore seniors who suffer from depression together with alcohol abuse are at an increased risk of suicide.
Barriers to identifying and treating seniors with alcohol abuse problems
The high number and the interconnectedness of older adults’ physical and mental health problems make the diagnosis and treatment of their alcohol abuse more complex than for the other populations. The barriers to effective treatment include;
- Lack of awareness. A lack of awareness or denial of the signs of alcohol abuse together with the stigma associated with seniors alcohol abuse from the community presents a barrier to the identification and treatment of the problem. Where adults attribute their alcohol problems to a breakdown in morals, they are not likely to seek treatment. Widespread awareness to encourage acceptance that the problem of alcohol abuse does exist within the seniors in our communities would go a long way towards the treatment of the problem.
- This describes the tendency of society to assign negative stereotypes to older adults and to explain away their problems as a function of being old rather than looking for specific social, medical or psychological causes. The society may, therefore, deem not worthy treating seniors with alcohol abuse problems because of the negative notion that “they are likely to die soon”.
- Clinician behavior. Unfortunately, encounters between the seniors and physicians have become shorter, with problems related to alcohol abuse increasingly competing for discussion time against other health problems. Physicians, family members and the older patients themselves typically place a higher priority on physical conditions such as renal failure, heart problems than on alcohol abuse.
- Enabling attitudes and behaviors. Enablers such as family and friends may want to protect the seniors from embarrassment and as such end up misrepresenting the substance use problem.
- Some seniors do not want to admit that they have a problem and thus use denial, minimization, and rationalization to explain their behavior.
- Shrinking social support network. The unwillingness of friends and family to participate in the treatment process. The recommended treatment program may be long and time-consuming forcing family and friends to shy away.
- Transportation may prove problematic especially in rural communities that lack public transportation or in poor urban communities where accessing transportation can be dangerous.
- Affected seniors with no medical insurance may find it difficult to access treatment. Some recommended programs may be expensive and out of reach for most of the affected seniors due to the medication and specialized personnel involved in the treatment process.
The rate of alcohol abuse in seniors is greatly underestimated or overlooked for several reasons. Among them are the warning signs such as fatigue, insomnia or impotence which can also be attributed to any number of physical ailments common in seniors. Hospital personnel may miss the identification of alcohol abuse in seniors due to being focused only on the senior’s current medical complaint or being uncomfortable with questioning the seniors.
Often, the senior’s family and friends hesitate to address their drinking, believing that the person ought to be left alone to enjoy the final years of their lives. Unfortunately, the negative consequences and effects on the senior’s quality of life warrant intervention. The rate at which the alcohol abuse problem is missed within the health services setting means that identifying alcohol problems in seniors relies heavily on caregivers, friends, and family. Alcohol abuse has adverse effects on all organ systems. Seniors abusing alcohol are immunosuppressed meaning they are at an increased risk of infections. Cancers of the head, neck, and esophagus are associated with chronic alcohol abuse with liver cancer occurring at increased rates among seniors with cirrhosis. Depression, disturbed sleep, and insomnia are common among older adults who abuse alcohol.
Seniors usually have alcohol treatment needs that are unique to their particular stage of life. Effective treatment should, therefore, be tailored to address these individual needs, along with other medical, safety and psychiatric needs specific to the individual.