CONTENTS

Table of Contents
Introduction

1. Overview
2. Recognizing Alcohol Misuse and Abuse in Older Adults
3. Alcohol and Aging
4. Diagnosing Alcohol Problems in Older Adults
5. Recognizing Other Forms of Substance Abuse
6. Prevention and Early Intervention Strategies
7. Treatment
8. Outcomes and Cost Issues in Alcohol Treatment for Older Adults
9. Legal and Ethical Issues

Supplements
Resources

At Any Age, It Does Matter:
Substance Abuse and Older Adults (for Professionals)

Lack of Attention to Substance Abuse in Older Persons

Even as the number of older adults suffering from alcohol and drug-related disorders climbs, the situation remains underestimated, underidentified, underdiagnosed, and undertreated. Until relatively recently, alcohol and psychoactive drug misuse was not discussed in either the substance abuse or the gerontological literature.^3,8,9

Because of insufficient knowledge, limited research data, stereotypes, and hurried office visits, health care providers often overlook substance abuse and misuse among older adults. Diagnosis may be difficult because symptoms of substance abuse in older adults may mimic symptoms of other medical and behavioral disorders common among this population. These include diabetes, dementia, and depression.

Often drug trials of new medications do not include older subjects. Thus, a clinician has no way of predicting or recognizing an adverse reaction or unexpected psychoactive effect.

Other factors responsible for the lack of attention to substance abuse include the current older cohort’s disapproval of and shame about use and misuse of substances. Many are reluctant to seek professional help for what they consider a private matter. Many relatives of older individuals with substance use disorders, particularly their adult children, are also ashamed of the problem and choose not to address it.

Ageism also contributes to the problem and to the silence: Younger adults often unconsciously assign different quality-of-life standards to older adults. Such attitudes are reflected in remarks like, “Grandmother’s sherry is the only thing that makes her happy,” or “What difference does it make; he won’t be around much longer anyway.”

There is an unspoken but pervasive assumption that treating older adults for substance use disorders is not worthwhile. Behavior considered a problem in younger adults does not inspire the same urgency for care among older adults. Along with the impression that alcohol or substance abuse problems cannot be successfully treated in older adults, there is the assumption that treatment for this population is a waste of health care resources.

These attitudes are counterproductive and rest on misperceptions. Most older adults can and do live independently. Only 4.6 percent of adults over 65 are nursing home residents or receiving personal home care.¹⁰

Furthermore, Grandmother’s cocktails aren’t cheering her up. Older adults who “self-medicate” with alcohol or prescription drugs are more likely to characterize themselves as lonely and to report lower life satisfaction.¹¹ Older women with alcohol problems are more likely to have had a problem-drinking spouse, to have lost their spouses to death, to have experienced depression, and to have been injured in falls.¹²

The serious effects of alcohol and drugs make it essential to recognize and treat problems in this vulnerable population. Preventing the harmful effects of substance abuse can give older people longer, more productive, and healthier lives. In addition, the high costs, economically and socially, associated with alcohol and drug misuse among the elderly can be avoided.