Elderly Alcohol Abuse 

An alarming new study shows that alcohol-related death rates more than doubled in the past two decades, with particularly high levels among older Americans.

"Alcohol is the leading avoidable cause of premature death and disability in the United States," says Charles H. Hennekens, M.D. an author of the study published in the American Journal of Medicine. Within high-income countries, up to 87% of older people use alcohol, with up to 45% at risk of health complications resulting from their alcohol intake.

The dramatic increase in alcohol-related deaths (such as from cirrhosis and alcohol poisoning) was especially high among 55- to 64-year-olds. That group had the highest level of mortality - with 39.3 deaths per 100,000 people. The numbers rose from 15.9 to 27.1 deaths per 100,000 for 65-to74-year-olds.

Why We Hesitated to Intervene

Most case workers who work with the elderly admit that they struggle with how to handle alcohol use among the elderly. "We don't believe that alcohol abuse is a problem for the elderly in the first place, so we tend to overlook it," says a social worker from Des Moines. "Especially if it causes no harm to the client or to anyone else."

• Judgements of whether older care recipients’ drinking warrants intervention are complex.
• Case workers realize that their clients’ quality of life is increased when they get to drink “their little whiskey before bedtime”.
• Social workers also note that alcohol can play a central role in older people’s social lives, positively contributing towards their quality of life.
• Care providers note the role of alcohol in coping with loss of purpose, which they associated with retirement, bereavement, and loneliness in later life.
• Another general expectation is that elderly don’t consume alcohol, especially not older women, according to the home care managers. One home care manager describes one elderly woman who she first thought had a problem with her memory and the relatives responded with: ‘Memory problems! She was drunk!’
• Older people must weigh up potential risks against the benefits they perceive from drinking in making decisions regarding their intake. However, most older adults who experience health consequences from their drinking do not recognize alcohol’s role. Awareness of what constitutes lower risk alcohol use is poor amongst the older age group.
• Social workers experienced that many of their older patients were lonely and, therefore, used alcohol to reduce their strain. Structural changes in their lives and in society, such as children having moved out or were too busy with their own lives, loss of friends, dependency because of poor health, and few meeting places for older people, were seen as reasons for loneliness.
• “Many of my elderly clients began using alcohol to cope with the feelings of emptiness and grief following their partner’s death and continued to drink until it became a way of life, and they were effectively dependent upon alcohol," one social worker told us.
• Care workers also had a very ‘black and white’ view of alcohol-related problems: a person was either alcoholic or did not have a problem. There seemed to be little understanding that some older people may experience alcohol-related problems when drinking a moderate amount, for example, because they have impaired balance.
• Care providers reported dilemmas stemming from the older person’s right to self-determination: "The elderly have the right to decide everything in their everyday life. Within elderly care the right to self-determination principle must be applied, regardless of whether or not they have alcohol problems."

An Enlightened Approach

Providers will need support and training to recognize and provide appropriate intervention for drinking amongst older care recipients. Health and social care settings provide a context to screen for hazardous use, identify risks associated with medicine use or health state, and where older people can be supported to make healthier decisions regarding their drinking.

• Caretakers who are working to show more empathy and create personal relationships and trust with the elderly in their care will enable this topic to be more easily discussed.
• “For me it’s easier if I meet them at the hospital because nurses and doctors say, 'When they came to us, they had a blood alcohol level of 2.8 and maybe drinking has become a bit too much lately,' then I don't have to bring it up. It makes it much easier. Then you have another opening to discuss the topic.”
• Most case workers also felt more confident raising the issue of alcohol consumption while undertaking scheduled health checks, when alcohol use could be addressed as simply one risk factor covered in a broader health-related conversation.
• Formal "Dangers of Alcohol Abuse" education sessions for the entire elderly population avoid singling out any individual client.
• Scientific discussions with individual elderly clients about the effect of alcohol on prescription medications.
• Family intervention session when the alcohol abuse problem becomes critical, and the client remains in denial.
• Always educate and advise. Never discipline or direct.

Social workers are challenged professionally to support and educate elderly clients at risk of alcohol abuse but as usual, they are stepping up and accepting yet another difficult challenge. Bravo.