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)

Information To Gather During an Assessment

Focus Area: Physical condition
Objectives:

• Extent of acute and chronic physical problems
• Health issues that need immediate attention
• Remedial care needs

Questions To Answer: Will the person require detoxification? Are there physical or mental health problems that need attention? What is the average number of drinks per week consumed in the past 6-12 months? What is the highest number of drinks consumed on a drinking occasion in the past 6-12 months? What medications are being taken (or not taken)? Are nutritional needs being met?
Special Considerations: Withdrawal in older persons is more complicated than in younger adults. The physical and behavioral signs indicating tolerance or withdrawal can be subtle. Often, the older person does not exhibit obvious signs of intoxication. Reports of alcohol consumption should be translated into number of standard drinks.

Focus Area: Mental status
Objectives:

• Evidence suggesting presence or absence of co-occurring mental disorders, such as depression or anxiety disorders
• Evidence suggesting presence or absence of cognitive impairment
• Status of current key relationships, e.g., cohabiting spouse or partner, adult children, staff and other residents in residential care facility, personal physician and other health and social service providers

Questions To Answer: Are there established psychiatric problems that have been treated in the past? Does this treatment relationship require repair or reestablishment? Are there other mental and other problems that require exploration and intervention? Will the person require a protective environment? Is the drinking/drug abuse an attempt to cope with loss, loneliness, depression, or boredom?
Special Considerations: There may be losses that the person needs to grieve and resolve or depression that needs to be treated. Screening for depression is often done using the Geriatric Depression Scale.

Focus Area: Cognitive functioning
Objectives: Signs of cognitive impairment
Questions To Answer: Does the person have any limitations in cognitive functioning? Does the person have the ability to give accurate information about self?
Special Considerations: A person’s cognitive functioning could be affected by alcohol or drugs, a non-alcohol-related dementia, depression, or other factors. Alcoholism can lead to dementia. Dementing illnesses caused by alcoholism are Wernicke’s encephalopathy, Korsikoff’s syndrome, and alcohol dementia. Screening for dementia can be done using a number of tests, such as the Folstein Mini-Mental Status.

Focus Area: Functional status
Objectives: Level of independence
Questions To Answer: Is the person capable of self-care?
Special Considerations: Some older people struggle with living independently. Shopping, cooking, and personal hygiene may be difficult, particularly if they have been abusing alcohol. Assessing ability to perform activities of daily living (ADLs) and instrumental ADLs is important for determining level of functioning, particularly if the person lives alone.

Focus Area: Available support systems
Objectives: Family and other resources
Questions To Answer: Who is available to give collateral information? Who is available to give physical and emotional support during and after treatment? What kind of support are others willing to provide?
Special Considerations: The support that is available is critical for planning treatment and aftercare.

Focus Area: Motivation for seeking treatment
Objectives:

• Willingness to participate in treatment and aftercare
• Type of treatment

Questions To Answer: What is the person’s current motivation for seeking help? What does the older person identify as his or her problem?
Special Considerations: Although there may be denial of an alcohol or drug problem, the older person has some concern that is motivating him or her to seek help. Focusing on what the older person identifies as problematic is critical to developing a trusting relationship. Problems presented by the older person may focus on:

• Fear of losing independence
• Limited income
• Change in living arrangements
• Lack of support network
• Widowhood
• Lack of transportation
• Assistance with activities of daily living

Motivation is not just the responsibility of the problem drinker. It is the result of the interaction between the drinker and others, including the professional caregiver.

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