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Alcholism in the Elderly: A Growing Concern
by David Bross, MD
If you were asked to describe an alcoholic, the odds are your description would not include the elderly man or woman who drinks one to two drinks a day in the comfort of home. Yet due to the effects of aging, what appears to be a harmless and acceptable daily routine in some cases may represent a serious medical problem-alcoholism.
As the "baby boom" generation ages, it becomes more urgent to address this underrecognized and undertreated problem. It is estimated that up to 15% of individuals over age 65 suffer from alcoholism and another 5% or more are dependent on other drugs, particularly prescription sedatives and pain relieving medications. If these numbers seem shockingly high, it is because the problem consistently goes unrecognized.
RECOGNIZING THE PROBLEM
There are two types of alcoholism in the elderly-- early onset and late onset. The individual with early onset alcoholism tends to have a more obvious problem -- a severe, lifelong battle with the disease, multiple medical, psychological and social problems, and often a family history of alcoholism. While slightly more the 50% of elderly alcoholics fall into this category, the remainder suffers from late onset alcoholism, a more subtle illness that often goes untreated. Late onset alcoholism is often triggered by a crisis -- loss of a spouse, medical illness, or even a seemingly positive event, such as retirement. Both forms of alcoholism routinely go untreated. Why is this?
Denial and shame are hallmarks of the disease at any age, but are sometimes more pronounced in seniors because of social and family expectations. We do not wish to think of mother, father, or grandparent as having an alcohol or drug problem, nor do many physicians or mental health workers for that matter -- thus, denial and shame are present at every level. This is where a psychiatrist with experience in treating addictions can be helpful.
HOW CAN ONE OR TWO DRINKS BE A PROBLEM?
As a person ages, total body water volume decreases steadily. Therefore, as alcohol is consumed, even small amounts (one or two drinks) are concentrated more readily in the bloodstream and can have the same or worse impact on one's mental and physical state than many more drinks in a younger person. Additionally, there are certain brain regions that become increasingly sensitive to the effects of alcohol as an individual ages.
OFTEN OVERLOOKED WARNING SIGNS THAT A SENIOR CITIZEN MAY HAVE A DRINKING PROBLEM:
1) High blood pressure that does not improve with medication
2) Frequent falls or unsteadiness
3) Urinary incontinence
4) Stomach pain or gastritis
5) Confusion or memory loss
The starting point of treatment should be a complete physical examination by a family physician or internist along with a comprehensive assessment by a psychiatrist. The psychiatrist will gather history from the elderly person and family with special attention to other psychiatric conditions commonly seen with alcoholism. Depression, manic-depression (bipolar disorder), anxiety and sleep problems, as well as dementia including Alzheimer's disease, often coexist with alcohol and other drug dependencies. Medications are now available to treat these conditions, as are newer medicines to reduce cravings for alcohol.
Most importantly, treatment focuses on teaching the elderly alcoholic to identify triggers for his or her drinking and to develop a support system through self-help programs like Alcoholics Anonymous (AA). There are also specialized individual and group therapies offered by a number of treatment programs in the region.
Should you or a loved one have further questions, please contact one of the following resources:
National Clearinghouse for Alcohol and Drug Information
Long Island Council on Alcoholism and Drug Dependency
(516) 747-2606 or (631) 979-1700
Family Consultation Center -- Senior Recovery Program
Hillside Hospital, Long Island Jewish Medical Center
North Shore University Hospital Drug Treatment
and Education Center
ABOUT THE AUTHOR:
David P. Bross, MD, is an Assistant Clinical Professor of Psychiatry at Albert Einstein College of Medicine. He is Medical Director of two substance abuse treatment programs affiliated with Long Island Jewish Medical Center/Hillside Hospital -- the Family Consultation Center in Mineola and the Family Treatment Program in Bayside. He is a graduate of the Albert Einstein College of Medicine and completed his residency and fellowship at Long Island Jewish Medical Center. He is Board Certified in General Psychiatry and Addiction Psychiatry.