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 Comorbidities

Studies have shown that the most common health problem among alcohol-dependent older adults is alcoholic liver disease. Chronic obstructive pulmonary disease, peptic ulcer disease, and psoriasis also are found much more frequently in older alcoholics than in older adults without alcohol problems. Alcohol also appears to be a risk factor for:

• Myopathy
• Cerebrovascular disease
• Gastritis
• Diarrhea
• Pancreatitis
• Cardiomyopathy
• Sleep disorders
• HIV/AIDS-related diseases
• Intentional and unintentional injuries⁴⁶

Malnutrition among older adults may be due to such conditions as poverty or a cognitive dysfunction. It is especially important to diagnose and correct the problem. Older substance-abusing adults on fixed incomes frequently have to choose among buying food, the prescriptions they need to manage illness, and the substance they abuse. If malnutrition is caused by economic conditions, social service agencies or private food-related programs can be brought in to help alleviate the problem.

Poor nutrition also may stem from a life change such as a spouse dying. An older person may stop preparing meals if he or she no longer has someone to cook for or eat with. A bereaved or frail person may not have the energy to shop or cook.

Many adults with alcohol problems "drink their calories" instead of eating food. Along these same lines, a provider should determine whether the older person is dehydrated, another possible indicator of alcohol problems.

Acute alcohol withdrawal syndrome is more protracted and severe in older adults than in younger adults.^47,48 Because there is no research on the recent practice of outpatient detoxification for older adults, very careful assessment is warranted before detoxification from any drug; outpatient detoxification may not be appropriate for older adults who are frail or who have a comorbidity.

Losses in vision and hearing are common in later life. Whether the older person can see or hear can affect the quality of information obtained during an assessment. Correction of sensory deficits may be necessary for the client to participate effectively in treatment.

Just because an older person has glasses or a hearing aid does not mean that they work optimally. An older person on a fixed income may have "made do" with an old pair of glasses or a hearing aid that is no longer effective. Finally, a person with sensory changes and chronic health problems often will fatigue easily. Rest periods may be needed during assessment interviews.