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)

Assessment

Assessments can be used to confirm an alcohol or drug problem, characterize the dimensions of the problem, and develop an individualized treatment plan. For purposes of insurance or other funding resources, the assessment should follow criteria in the DSM-IV or other relevant criteria.

Sometimes, standard criteria do not apply directly to planning older adults’ treatment. The unqualified application of such criteria is problematic in older adult populations. It is possible for symptoms of other medical diseases and psychiatric disorders to greatly overlap with substance-related disorders. Providers should look for other disorders, such as dementia, before confirming alcohol or drug problems.

Factors To Consider

Because the assessment process can be time-consuming and expensive, a sequential approach is suggested that looks at various dimensions of an older adult’s suspected problem in stages so that unnecessary tests are not conducted.⁴¹ The following factors should be considered when conducting an assessment:

• Time required for adequate assessment
• Activities of daily living (ADLs), which include ambulating, bathing, dressing, feeding, and using the toilet
• Instrumental activities of daily living (IADLs), which include managing finances, preparing meals, shopping, taking medications, and using the phone.
• Special needs, including:
  • Housing
  • Health care
  • Social support, companionship
  • Nutrition and food preparation
  • Financial support
  • Legal help
  • Transportation
  • Time management
  • Help with ambulation, bathing, and other ADLs
• Chronic health problems
• Sensory changes
• Mental status
• Available support systems
• Motivation for seeking help
• Sources of information, including:
  • Older person
  • Spouse or significant other
  • Children and stepchildren
  • Concerned others
  • Home visits
  • Health care and social agency records
  • Key informal and formal caregivers

Guidelines indicate information to be gathered during an assessment.

Complete Health Assessments

For some older adults, it may be impossible to understand the true impact of their alcohol use or to recommend appropriate treatment services without a full assessment of their physical, mental, and functional health. Functional health refers to a person’s capacity to perform ADLs and IADLs.

Limitations in ADLs and IADLs, sometimes referred to as disabilities, can result in an inadequate diet, mismanagement of medications or finances, or other serious problems. These disabilities are major risk factors for institutionalization. Therefore, they are more likely than physical illness or mental health problems to prompt older adults to seek treatment.

Impairments in functional abilities are common in older adults with medical and psychiatric disorders. For instance, 90 percent of adults over the age of 65 require the use of glasses. Fifty percent have some degree of hearing loss.^42,43

Sensory impairments affect older adults in subtle ways that are not always immediately obvious to health practitioners but need to be anticipated, identified, and incorporated into treatment practices. Clinicians should ensure that older patients, for example, can read their prescriptions or hear what is said in a group therapy session.

When not considered and compensated for, functional impairments can obstruct treatment. For example, it would be futile to enroll an older patient who has limited mobility in a program housed in a facility with steep flights of stairs and no elevator. Likewise, it makes little sense to recommend an evening program to older adults who cannot drive at night and do not have someone else to drive them.

Alcohol use can diminish IADLs and ADLs. Although alcohol-related functional impairments are potentially reversible, they should be considered when planning a treatment regimen. There are known complications of and differences between alcohol use in men and women related to compromised functional abilities and ADLs.

In a recent study of older adults with a former history of alcohol abuse, impairment in ADLs was twice as common in women as in men.⁴⁴ In addition, alcohol use was more strongly correlated with functional impairment than were smoking, age, use of anxiolytics, stroke, or diminished grip strength.