Kate Spencer, 66, has been sober for over seven years. Although she worked full time and raised two children, her 34 years of drinking, she says "were not without a heavy cost." She finally sought treatment when she caught herself contemplating drink-filled hours of retirement, and her therapist told her that she was a "functional drunk." These days, she is speaking out, trying to help older people realize that it is never too late to change.
Alcoholism and drug abuse are silent epidemics in the senior population. Seventeen per cent of Americans aged 60 and over have serious problems with alcohol and drugs, reports the federal Substance Abuse and Mental Health Services Administration. Nearly one-quarter of Medicare hospital payments are for substance abuse cases, reports the National Center on Addiction and Substance Abuse. "We definitely see the problem among seniors in Vermont," says Beth Rizzon, Eldercare Clinician at the Howard Center for Human Services and the Champlain Valley Agency on Aging. In spite of these figures, alcohol and substance abuse among the elderly is frequently unreported, undiagnosed, or ignored.
The reason for the silence is that usually no one notices. Older people are less likely to get into trouble with the law. They drive less and are not often stopped for drunk driving. Since they are usually retired, their drinking does not cause them to lose their jobs. Families are too embarrassed to talk about their condition. Physicians and other service providers often do not recognize the problem, confusing the consequences of heavy drinking with depression, insomnia, poor nutrition, congestive heart failure, dementias, and frequent falls. Also, about one-third of elderly problem drinkers start their heavy drinking after age 60, often because of life-changes such as retirement or the death or disability of a spouse. That means their medical records do not mention alcohol abuse.
According to the National Institute on Alcohol Abuse and Alcoholism, hospital admissions for alcohol-related problems are the same as those for heart attacks among older Americans; but physicians and nurses are "significantly less likely to recognize alcoholism in an older patient than in a younger patient."
Funded by the state Health Department since 1989, the Coalition on Substance Abuse and Older Vermonters aims to break this silence by heightening awareness among service providers and seniors. Long-time board member Joy Mitchell, director of the Vermont Council on Problem Gambling, notes that many older people are not aware that metabolic changes associated with age make the size and frequency of their youthful drinks dangerous in their older years. Although they may never have had problems with alcohol when they were young, as they age their youthful drinking habits can lead to trouble. Many do not know that the recommended alcohol level for people 60 and over is no more than one drink per day – one drink meaning one 12 ounce can of beer, 1.5 ounces of liquor, or five ounces of wine.
Alcohol can be medically hazardous to older people even if the frequency and amount consumed do not add up to a formal diagnosis of alcohol abuse. Drinking can worsen common medical and psychiatric conditions associated with age, such as depression, high blood pressure, reduced bone density, and increased risk of falling. And mixing alcohol with over-the-counter and prescription medicines can be dangerous, even fatal. One way to gauge alcohol abuse outside of the numbers is to consider how and why you are drinking. Danger signals include: drinking because you are nervous, drinking as a way to cope with depression, and drinking to control pain.
Elderly people use prescription and over-the-counter drugs more than three times as much as the general population. Diagnosing drug addiction in older people is just as difficult as diagnosing alcoholism because seniors usually do not use street drugs. They abuse prescription medicines, like Valium and Xanax. Another form of drug abuse in seniors is often unintentional, says Mitchell. Many people take several drugs each day, prescribed by different physicians, and sold by different pharmacists. They often have no idea how their medications interact with each other and with alcohol.
David Kolok, new coordinator of the Coalition on Substance Abuse and Older Vermonters is planning a series of presentations at senior centers, meal sites, and senior housing complexes to help older people understand the issues and ask them to participate in the coalition. "I want to ask them how we can be of service and get them to help us spread the word," he says. His next presentation is on April 14, 11 am, at the monthly meeting of the Older Women's League, Flynn Avenue Housing Co-Operative meeting room, 288 Flynn Avenue, Burlington. Non-members are welcome.
Mitchell says that alcohol and drug rehabilitation services focus on the younger drinker and addict and "are not geared to senior needs and life styles." Coalition member Kate Spencer describes the current recovery programs as "full of 20-somethings with tattoos and studs." The good news, studies say, is that elderly people with drinking and drug problems can benefit from treatment at least as well as younger people.
"It's never too late. You're never too old to change and make a happy life for yourself and for those around you," says Spencer. "Don't be afraid of the tattoos."
Signs of Alcohol or Drug-Related Problems in Seniors
- Memory trouble after taking alcohol or medicines
- Loss of coordination
- Change in sleeping/eating habits
- Unexplained bruises
- Being unsure of yourself
- Feeling irritable and sad
- Unexplained chronic pain
- Wanting to be alone
- Failing to bathe or keep clean
- Having trouble finishing sentences, concentrating
- Difficulty in staying in touch with family and friends
- Lack of interest in social activity
What to do? Speak with your physician, say the experts at the Substance Abuse and Mental Health services Administration
Coalition on Substance Abuse and Older Vermonters, contact: David Kolok, 802-343-6503, kolok@comcast.net
Barbara Leitenberg writes on senior issues for the Champlain Valley Agency on Aging. This article originally appeared in the Burlington Free Press.
