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

Module 4: Diagnosing Alcohol Problems in Older Adults - Page 14 of 32

Special Issues

Impaired cognition interferes with screening, making it difficult to obtain complete and accurate answers. Although it is important to respect the older adult’s autonomy, input from family members or friends may be necessary in situations when a coherent response is unlikely. In this case, the screener should first ask for the older adult’s permission to question others on his or her behalf.

Sometimes screening unleashes a family member's simmering anger toward the older adult.

If possible, family and friends should be interviewed in private, using a nonconfrontational approach. For example: "I’m concerned about your father’s deteriorating condition and wonder if his use of alcohol may be having a negative impact. Have you or anybody else in the family had any concerns about his drinking?"

Because circumstances differ within families, family members may not know or may be unwilling to respond honestly to questions about drinking problems. Another question that skilled clinicians find useful is, "Has anybody in your family ever had a problem with drinking?" A positive response suggests that a problem may exist and that more indepth questioning should follow.

Sometimes screening unleashes a family member’s simmering anger toward the older adult for both past and current alcohol-related behavior. It is important to be alert to this possibility. It may be necessary to work with the family member to discourage a confrontation with the older adult when the screening ends.

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