Older Adults and Mental Health Part 3: Substance Abuse & Misuse

“Life is not the way it’s supposed to be. It is the way it is. The way you cope is what makes the difference.”
-Virginia Satir

Did you know that an estimated 17% of community dwelling older adults abuse substances, mainly alcohol? The abuse and misuse of alcohol by older adults is considered a significant public health concern in the U.S.¹ It can be difficult to diagnose abuse or misuse disorders as the signs and symptoms of substance/alcohol abuse appear similar to medical and mental illnesses that sometime occur in aging. For example, some people attribute forgetfulness and irritability to be part of the normal aging process, whereas it may occur because of drinking or inappropriately mixing medications with alcohol.

The U.S. Department of Health & Human Services refers to alcohol and substance abuse disorders experienced by older adults as a “hidden epidemic” that is underreported, underdiagnosed, and undertreated when compared to younger people.²

Consider the following scenario. Mrs. Smith appeared to be a typical 76-year-old widow living independently in the community. She fell at home and was taken to the emergency department of a local hospital where she was diagnosed with a broken hip. While older adults who fall are prone to fractures, the ED did not recognize alcohol as a contributing factor. However, during her hospital admission, Mrs. Smith acknowledged that she often uses alcohol to cope with and “self-medicate” her arthritis pain.

Often it is shame, embarrassment, cultural values, or other influences that hinder older adults from discussing drinking and related coping behaviors with health professionals. Myths and stereotypes also compound the problems related to substance abuse and treatment of older adults.

Myths and Stereotypes: Alcohol/Substance Abuse and Older People

It’s just a few glasses of wine, what’s the big deal. (Minimization)
At his age, alcohol is all dad has left to enjoy! (Rationalization)
Mom drinks, but her fall was due to tripping over the cat. (Denial)
There are no recovery programs for seniors. (Inaccuracy)

Professionals working with older people act in their best interest by using evidence-based practice techniques to screen and recommend treatment. There is good evidence that screening helps to identify older adults whose alcohol consumption pattern increases their risk for chronic illness and death. In addition, it has been found that counseling about reducing alcohol intake is effective for as long as 6-12 months.³ Several evidence-based assessment tools are available for use in screening for alcohol problems. A simple alcohol-screening tool we suggest is CAGE, and it takes only a minute to administer.

CAGE – Acronym for brief screening tool that covers several assessment areas:

Cut down? Has the older person attempted to cut down on drinking?
Annoyance? Have friends or family asked the older person to cut down on drinking?
Guilt? Has the person felt guilty about drinking?
Eye Opener? Has the older person needed a drink in the morning to get started?

Two “yes” responses indicate that further screening is warranted. (75%-95% specificity)⁴

According to the Geriatric Mental Health Foundation, substance abuse involves:

Inappropriate use or misuse of OTC or prescription medications such as tranquilizers.
Mixing prescription medications with alcohol or other medications not prescribed.
Taking too much or not enough medications.⁵

Older people may not be aware of side effects of intentional or accidental misuse of medications or the consequences of combining with alcohol, dependency or withdrawal issues. As Health professionals, we need to educate ourselves, older people and their families about reducing alcohol and medication misuse or abuse. Regardless of whether alcohol is used as a remedy for loneliness, to self-medicate, or to cope with pain, abuse is dangerous.

Recommended Resources – Evelyn’s Picks

References

1. Blow, F.C. (2002). Misuse and abuse of alcohol, illicit drugs, and psychoactive medications among older people. Generations xxvi (1), 50-54.

2. The Substance Abuse and Mental Health Services Administration (DHHS) TIP-Treatment Improvement Protocol.

3. Summary of U.S. Preventive Services Task Force (2004). Annals of Internal Medicine. Screening and counseling to reduce alcohol misuse.

4. CAGE Screening Instrument, National Institute of Alcohol Abuse and Alcoholism.

5. Substance Abuse and Misuse Among Older Adults, Geriatric Mental Health Foundation.

GERO GEMS is a monthly publication of the Center for Aging with Dignity. Compiled by Evelyn Fitzwater, this publication is designed to raise awareness of aging and related issues impacting health care professionals and our society as a whole.

For more information:

Go to the Senior Health health topic.