Examining the issue of alcohol use by older adults may often create a sense of discomfort for society. This discomfort stems in part from our belief as Americans in the right of self-determination – to make decisions for ourselves and live the way we choose. Other underlying factors that contribute to discomfort or feelings of reluctance to address concerns about potential misuse of alcohol include a sense of stigma that may be associated with substance abuse, personal and cultural attitudes about aging, lack of understanding of the effects of alcohol on older people, and the belief that lifelong patterns cannot be changed.
When alcohol misuse and addiction are not addressed, however, they create issues that affect an older adult’s ability to remain independent and the quality of life. The Council of Southeast PA, an affiliate of the National Council on Alcoholism and Drug Dependence, identifies some of these issues as increased isolation, physical health problems (older people are hospitalized more often for alcohol related problems than for heart attacks), impaired memory, and increased risk for accidents and injuries.
Older adults are more likely to hide their alcohol use and less likely to seek help than younger adults, however, we’ve already mentioned that those who started drinking later in life have a higher rate of recovery than their younger counterparts, and that the involvement of family and friends is an important component of this recovery. So how does one recognize problem drinking and encourage a loved one to seek help? Some signs may be obvious, such as a large number or the consistent presence of empty alcohol bottles in the trash, secretive behavior, increased depression or angry outbursts, the smell of alcohol on one’s breath or the use of mouthwash to hide it, and slurred speech or other behaviors indicative of intoxication. Other signs are more generalized, and could be attributed to any number of health conditions including weight loss or gain, insomnia, neglect of personal appearance, feelings of stress or fearfulness, loss of interest in hobbies and social activities, and impaired memory or judgement.
Questions about alcohol use may be answered more easily and honestly when incorporated into a conversation about other health-related behaviors and practices. One individual that I spoke with, who is in recovery, stated she denied she had a problem until she took a written screening and saw her answers in print. The following examples of questions, taken from the Short Michigan Alcoholism Screening Test – Geriatric Version, may help someone identify a potential misuse of alcohol:
- When you feel lonely, does having a drink help?
- Do you usually take a drink to relax or calm your nerves?
- Have you ever made rules to manage your drinking?
- Have you ever increased your drinking after experiencing a loss in your life?
- Do you drink to take your mind off your problems?
- After a few drinks, have you sometimes not eaten or been able to skip a meal because you didn’t feel hungry?
- Does alcohol sometimes make it hard for you to remember parts of the day or night?
This screening test contains a total of ten questions, and if the individual can answer yes to at least two of them (happening within the past year), a potential alcohol problem exists.
When approaching an individual about potential alcohol misuse, it is important to maintain a non-confrontational attitude. Hazelden, a nonprofit organization which provides a variety of services related to alcoholism and drug addiction, offers the following suggestions:
- Start the discussion at a time of the day when the individual is NOT drinking.
- Keep the discussion focused on present issues and avoid bringing up painful or volatile issues from the past.
- Approach the subject a little at a time, instead of trying to have an extended discussion right from the start.
- Present your observations using “I” statements, such as “I’m concerned” or “I’ve noticed”.
- Talk about how the alcohol use is affecting people or situations that the individual cares about.
- Reinforce the individual’s positive qualities and share happy memories.
- Avoid speaking to and treating an older adult like a child. Be direct but gentle.
- Avoid using terms like “alcoholic” or “addict”.
- If the individual is in denial or becomes argumentative, re-approach the subject at another time.
Concepts of recovery are important to understand in order for alcohol misuse to be successfully addressed. Some of these concepts will be discussed next week.
Karen Kaslow, RN
Information in this article was obtained from training materials for peer recovery support providers, and was provided by Kristin Noecker, Program Coordinator for The RASE Project, 8 S.Hanover St., Carlisle. Phone: 717-249-6499.