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November 19, 2014

Older Alcoholics

Reuel S. Amdur

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Between 6 and 10% of seniors are estimated to have an alcohol problem. Metabolizing alcohol is more difficult for seniors, so an amount that was not a problem when younger may be one now, especially in the case of women.

Alcohol needs to be seen in the person’s total situation, including physical condition and mental functioning.  For example, does the person have diabetes or depression?  If there is cognitive impairment, there may not even be an awareness of how much is being consumed.  And quantity is an issue.

One drink a day for a man, less for a woman is considered low risk, but other things may make even these amounts problematic.  Other things may interact with alcohol—prescribed drugs, over-the-counter medication, herbal remedies, marihuana, and illegal drugs. 

Health care workers should ask the elderly about alcohol consumption, including such things as weekly consumption and maximum consumption in the last three months.  Where suspicion of a problem arises, the Short Michigan Alcoholism Screening Questionnaire (Geriatric Version) might be applied:

--Have you ever felt you ought to cut down on your drinking?

--Have people annoyed you by criticizing your drinking?

--Have you felt bad or guilty about your drinking?

--Have you ever had a drink first thing in the morning to steady your nerves or get rid of a hangover (eye opener)?

People who drink more than the suggested amount without serious problems ensuing may still be considered to be moderate drinkers.  They do not have withdrawal symptoms and are usually able to carry on their responsibilities, even taking more than 14 drinks a week. A person who is dependent on alcohol typically takes 40 or more drinks a week, suffers withdrawal symptoms, experiences social and physical consequences, and neglects responsibilities.  Withdrawal symptoms can include seizures or d.t.’s (delirium tremens).

Someone with moderate consumption may be able to be convinced to cut down with an educational approach.  If the problem is more serious, health worker contact should be frequent, with alcohol on the agenda.  There are medicines to lessen the urge, but they require medical monitoring because of side effects.  To promote self-awareness, the drinker may be asked to keep a diary of drinking and may be asked when, where, and how much he intends to drink and may be advised to lessen the impact of drinking by drinking mixed drinks, spacing drinks, and avoiding places where drinks are available.

Too often, health care providers tend to downplay substance abuse among older people.  They may feel that they are old, not likely to change, and they lack responsibilities, so why not let them have their little pleasure or release? 

This attitude does not value the elderly and recognize that they have the same right to care that young people have.  Older people can benefit from counseling and treatment.  Helping professionals need to accept this broader ethic and should be prepared to address the needs of older people with alcohol and other substance abuse problems. 

Reuel Amdur is a social worker who graduated from the University of Washington.

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