CONTENTS

Table of Contents
Introduction

1. Overview
2. Alcohol
3. Prescription and Over-the-Counter Medications
4. Barriers to Recognizing Problems
5. Signs and Symptoms of Misuse
6. Talking About Sensitive Issues
7. Assessing a Problem
8. Preventing Misuse
9. Intervention and Treatment

Supplements
Resources

Alcohol, Medication and Older Adults
For Those Who Care About or Care for an Older Adult

Starting the Conversation

Here are two case studies to give you some practice with starting the conversation.

Case Study One

Mrs. S. is 74 years old and lives alone. Two months ago she fell and broke her wrist. She complains of heartburn and dizziness. She was diagnosed with alcoholism 10 years ago and has cirrhosis of the liver, stomach bleeding, and arthritis.

A caregiver assists Mrs. S. with personal care and cleaning and provides a meal. Mrs. S. often does not eat her meal. Mrs. S. wants to remain in her home and does not acknowledge having an alcohol problem.

Assume you are the caregiver. If Mrs. S. continues to deny an alcohol problem, how might you deal with the denial? What might you say or do to express your concern?

Some Suggestions

• Reassure Mrs. S. that you care about her and want to be able to help her or help her help herself.
• Do not criticize Mrs. S. with phrases like "You're always drunk." Rather, be specific and use phrases such as "I'm concerned that your heartburn and dizziness may be related to your use of alcohol."
• Point out that if Mrs. S. continues to drink alcohol, she may not be able to remain at home due to falls, confusion, or malnutrition. If she cares about what others are saying about her or if she cares about her grandchildren, remind her how confusion, falls, or hospitalization might limit her ability to see the ones she loves.
• Encourage Mrs. S. to continue to talk to her doctor about options. If the doctor is not responsive, find another doctor.
• Keep talking in a caring, nonjudgemental way about the problem over time.
• Talk to a family member about your concern.

Case Study Two

Mr. W. is 67 years old and recently retired. His wife died 5 years ago and his brother died a year ago. For the past year, he has had a local liquor store deliver a case of beer every week. He states that he does not drink very much and that "it's only beer."

Assume Mr. W. is your father. How might you start the conversation? What might you say?

Some Suggestions

• Acknowledge your father's recent loss and try to get him to speak about the loss. Try something like, "Dad, I am concerned about the amount of beer you have been drinking since Mom and your brother died. I know you miss them very much, but I'm worried that drinking will only bring on more problems and make you feel worse."
• Increase social involvement with friends, interests, activities, clubs.
• Provide information that even small amounts of beer can contribute to depression.
• Be specific.
• Encourage your father to call his doctor. Expressing concern for your father's health and suggesting that he see his doctor may provide an avenue to talk about the problem.

Possible Reactions and How To Respond

Although you can be prepared and do your best to express your concern about the alcohol or medication use of another person, you cannot control how he or she responds to your concern. Denial plays a large role in the use and abuse of alcohol and medications. Don't be surprised if you get some of the following reactions.

"It's just a phase. I'm only drinking more now because I am depressed over. (a loss)."
Remind the person that alcohol is a depressant and will only make the depression worse.

"Leave me alone. It's none of your business!"
Let the person know that you are bringing this up because you care. If the person gets angry, close the conversation and bring it up another time.

"I just drink because I'm lonely. There's nothing to do once you get old."
Remind the person of the enjoyable things he or she used to do and can still do.

"I'm anxious these days and need the tranquilizers to calm my nerves."
Offer the person alternative ways to deal with stress and state that the drugs could be affecting his or her health.

"The doctor says it's ok."
Ask if the doctor knows how many prescription and over-the-counter medicines the person is taking and how much the person is drinking.