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)

Opportunities To Screen

Although the vast majority of older adults (87 percent) see physicians regularly, their service providers estimate that 40 percent of those who are at risk do not self-identify or seek services for substance abuse problems on their own.³² Moreover, they are unlikely to be identified by their physicians despite the frequency of contact.

Most older adults live in the community. Contrary to popular belief, fewer than 5 percent live in nursing or personal care homes. Thus, training supervisors in such residences does not offer a reasonable strategy for increasing problem identification.

To ensure that older adults receive needed screening, assessment, and intervention services, stepped-up identification efforts by health care providers are needed. Multitiered, nontraditional case-finding methods within the community are essential.^32,33

Most older adults see a medical practitioner several times per year, often for conditions that lend themselves to collateral discussion of the patients’ drinking habits. Thus, the primary care setting provides an opportunity for screening that is currently underutilized, as is the hospital.³⁴

Home health care providers have unparalleled opportunities to observe isolated, homebound seniors for possible problems. If substance abuse is suspected, they can administer a nonthreatening screen.

Health care workers are not the only people who can identify substance abuse among older adults. Friends and family and staff of senior centers, including drivers and volunteers who see older adults on a regular basis, are intimately acquainted with their habits and daily routines. Frequently they are in the best position to detect behavioral changes that signal a possible problem.

Leisure clubs, health fairs, congregate meal sites, Meals-On-Wheels, and senior daycare programs also provide venues in which older adults can be encouraged to self-identify. The National Council on the Aging, for example, sponsors a depression awareness program that helps people identify signs and symptoms of depression in themselves and their loved ones. It avoids confidentiality problems and seems to offer a feasible model for mass screening of drinking problems.

Although younger substance abusers are frequently identified as a result of an action initiated by a family member, spouse, employer, school, police, or the courts, many older adults’ substance abuse problems remain undetected. Health, social service, and community service providers need to understand that alcohol and prescription drugs can pose serious problems for older adults and take the initiative in getting them the help they need. Otherwise, quality of life will be diminished, independence compromised, and physical deterioration accelerated.