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)

Physical Effects of Alcohol Use

Examples of the physical damage associated with alcohol may be seen with the Hepatic Pathology Index (in particular, steatosis, or fatty liver, and cirrhosis). Alcohol abuse can also accelerate the otherwise normal age-related decline in physiologic functioning. It is a significant cause of increased morbidity and mortality in older adults.

Older persons also experience changes in sleep patterns.⁸ Increased episodes of sleep with rapid eye movement (REM), decreased REM length, decreased stage III and IV sleep, and increased awakenings are common patterns. All of them can be worsened by alcohol use.

Moeller and colleagues demonstrated in younger subjects that alcohol and depression had additive effects on sleep disturbances when occurring together.⁹ One study concluded that sleep disturbances, especially insomnia, may be a cause of late-life alcohol problems or relapse.¹⁰

It is a common myth that alcohol helps sleep. Although alcohol can decrease the time it takes to fall asleep, it can lead to insomnia later. Many people wake up after a few hours and have difficulty falling asleep again. In addition, after awhile, alcohol no longer helps people fall asleep.

The key to healthy sleep is good sleep hygiene. Following are some tips to share with older adults:

• Consume less or no caffeine and avoid alcohol.
• Drink less fluids before going to sleep.
• Avoid heavy meals close to bedtime.
• Avoid nicotine.
• Exercise regularly, but do so in the daytime, preferably after noon.
• Try increasing exposure to bright light in the evening, which may help you sleep longer in the morning.
• Try a relaxing routine, like soaking in hot water (a hot tub or bath) before bedtime.
• Establish a regular bedtime and waketime schedule.
• Use your bed only for sleep and sex.
• Only get into bed when you're tired.
• If you don't fall asleep within 15 minutes, get out of bed. When you're sleepy, go back to bed.
• While in bed, don't dwell on not sleeping or your anxiety will increase.
• Think relaxing thoughts: picture yourself soothed in a tub of hot water, or drifting to sleep, each muscle relaxed.

In addition, older people may be particularly bothered by noise. Because their sleep may be frail, it is more likely to be disturbed by lower levels of noise. Here are some ways to reduce noise:

• Ear plugs
• White noise, which comes from a noise-making machine such as a fan or generator
• Rugs
• Heavy curtains or drapes
• Double-pane windows
• Relaxing music or tapes

In addition, older persons are more likely than other age groups to have one or more chronic illnesses. Alcohol may affect the ability to take medications correctly. Medication use and misuse is discussed further in Module 5, Recognizing Other Forms of Substance Abuse.