Older Folks May Have Unhealthy Drinking Habits
Drinking and Alcoholism Among the Elderly
Single Question Screening
March 17, 2009 — The single screening question recommended by the National Institute on Alcohol Abuse and Alcoholism (NIAAA) accurately identifies unhealthy alcohol use in a sample of primary care patients, supporting use of this brief screen in primary care, according to the results of a cross-sectional study reported in the March 12 Online First issue of the Journal of General Internal Medicine.
"Unhealthy alcohol use is prevalent but under-diagnosed in primary care settings," write Peter C. Smith, MD, MSc, from Boston University School of Medicine in Boston, Massachusetts, and colleagues. "Screening and brief intervention by primary care physicians for those with unhealthy alcohol use reduces risky consumption. Because of this, practice guidelines recommend universal screening."
The goal of this study was to validate a single-item screening test for unhealthy alcohol use recommended by the NIAAA.
Adult English-speaking patients recruited from primary care waiting rooms were asked, "How many times in the past year have you had X or more drinks in a day?" (X = 5 for men and 4 for women). A positive response to this single-question screen was defined as more than 1. Patients were considered to have unhealthy alcohol use if a standardized diagnostic interview revealed the presence of an alcohol use disorder or if a validated 30-day calendar method showed risky consumption.
The interview was completed by 286 (73%) of 394 eligible primary care patients. For identification of unhealthy alcohol use, the single-question screen was 81.8% sensitive (95% confidence interval [CI], 72.5% - 88.5%) and 79.3% specific (95% CI, 73.1% - 84.4%). For identification of a current alcohol use disorder, the single-question screen was slightly more sensitive (87.9%; 95% CI, 72.7% - 95.2%) but was less specific (66.8%; 95% CI, 60.8% - 72.3%).
Test characteristics of the single-question screen resembled those of a commonly used 3-item screen. Subject demographics affected diagnostic performance of the single-question screen only minimally.
"The single screening question recommended by the NIAAA accurately identified unhealthy alcohol use in this sample of primary care patients," the study authors write. "These findings support the use of this brief screen in primary care."
Limitations of this study include refusal of almost half of the patients approached in the primary care waiting room to be screened for eligibility in the study; failure of approximately one fourth of eligible subjects to complete the study; report of substance use disorders in a higher-than-expected proportion of subjects, creating possible selection bias; and lack of validation of the single-question screen in languages other than English.
"The sensitivity and specificity of this single question was comparable to that reported for longer instruments in other studies," the study authors conclude. "These findings of validity support the use of this brief screen in primary care as recommended by NIAAA, which should, in turn, help with the implementation of universal screening for unhealthy alcohol use as recommended by national practice guidelines. Some patients who screen positive will have severe alcohol use disorders requiring referral to substance abuse treatment, while those who consume excessive amounts of alcohol but have not experienced severe health or interpersonal problems would benefit from brief intervention by the primary care provider."
The NIAAA supported this study. The study authors have disclosed no relevant financial relationships.
J Gen Intern Med. Published online March 12, 2009.
Medscape Online
Aging, Substance Abuse & A New Coalition
The current epidemic of prescription drug and alcohol misuse among aging adults is rooted in a complex set of causes, not the least of which is the wide spread perception that this segment of our population is “over the hill,” and of little functional value.
Since the mind-set installed by the Industrial Revolution, that the value of a human being is to be measured in terms of hourly production, older adults have been more and more alienated. Further, as life expectancy and population have increased, old age has been successfully defined by the medical industry as a disease. And, so defined, has also become a rapidly growing and highly lucrative market.
No one alive today remembers the world before the great Industrial Revolution, when older adults were not only a vital resource for valuable skills and useful information, but were also a respected source of wisdom and cultural continuity. However, with the advent of manufacture and information technology, this historical elder role was no longer needed; or so it seemed.
Older adults today are a powerful indicator of the mismatch between our technological society and the culture of traditional community. For thousands of years our generational balance was a matter of natural survival, with a high mortality rate at both ends of the life cycle (although the young have always outnumbered the old). But now, due to advances in medicine and medical technology, the old will soon outnumber the young. According to the U.S. Census Bureau: “People aged 65 and over will soon outnumber children under age 5 for the first time in history.”
By 2030 people over 65 will account for 20% of our nation’s population. And, if we continue to regard “them” as useless and “over the hill,” we will continue to experience aging adults as a liability; rather than as the valuable resource they actually can become. In an age when the whole wide world of complex information is at our fingertips, the value of life experience and a discerning elder consciousness may be more important now than ever. Besides, it should be clearly understood that no society on earth can afford to carry 20% of its population as “functionless.”
So what can we do? First of all we must begin to understand and respond to the futility, isolation and depression that contributes so much to the misuse of prescription drugs and alcohol among aging adults. Those of us who have been maginalized due to disability, or otherwise relegated to minority status, have some idea of the devastation that accompanies an outcast from the mainstream of this dynamic society. This is especially true for those who have learned so much from their decades of experience and involvement, only to be discontinued due to natural causes.
A local coalition of concerned volunteers and professionals, the Aging Adults Substance Abuse Prevention (AASAP) Coalition (through the Sonoma County Department of Health Services, Prevention & Planning Division), is now being formed to address the growing problem of substance misuse among aging adults. This coalition will work to accomplish a number of important goals: 1) to promote awareness of aging adult substance abuse issues through public education; 2) educate and train health care providers to screen, intervene in and treat aging adult substance abuse; and 3) sponsor a Sonoma County conference focused on addressing substance abuse in the aging adult population for the larger community.
This hidden epidemic among displaced souls is but one indicator of a wide spread, dehumanizing trend away from the core values of community in our society. We must once again recognize the utility of the common good and consciously participate in a transition toward the integration of all generations. What we do right now as a society to address the overwhelming increase of aging adults during the next few decades will determine our success, or failure, in adapting to resolve the potentially devastating problems that can accompany this inevitable, radical change.
© Rabon Saip 2009
HIDDEN EPIDEMIC
Substance abuse, specifically of alcohol and prescription drugs, among adults 60 and older is one of the fastest growing health care problems facing our nation. Yet, even as the number of older adults suffering from these disorders climbs, the situation remains under-estimated, under-identified, under-diagnosed, and under-treated. Until recently alcohol and prescription drug misuse, which currently affects up to 20 percent of older adults, was not even discussed in either chemical dependency or gerontological literature.
Because of insufficient knowledge, limited data, and hurried office visits, health care providers often overlook substance misuse among older adults. Diagnosis is difficult because symptoms of substance misuse often mimic symptoms of other common disorders in older individuals; such as diabetes, dementia, and depression. Additionally, drug trials of new medications often do not include older subjects, so a clinician has no way of predicting or recognizing an adverse reaction or unexpected psychoactive effect.
Other factors responsible for the lack of attention given to substance misuse in this population include the older adult's disapproval of and shame about misuse of substances, as well as a reluctance to seek professional help for what many in this age group consider a private matter. Relatives of older individuals with substance use disorders, particularly their adult children, are also ashamed of the problem and choose not to address it.
The attitudes of Ageism as well contribute to the problem, and to the silence. Younger adults often unconsciously assign different quality-of-life standards to older adults. Such attitudes are reflected in remarks like, "Grandmother's cocktails are the only thing that makes her happy," or "What difference does it make; he won't be around much longer anyway."
There is also an unspoken but pervasive assumption that it's not worth treating older adults for substance use disorders. Behavior considered a problem in younger adults does not inspire the same urgency of care in elders. Along with the impression that alcohol or substance misuse problems cannot be successfully treated in older individuals, there is the assumption that treatment for this population is a waste of health care resources.
These attitudes are not only callous, they rest on serious mis-perceptions. Most older adults can and do live independently. Only 4.6 percent of adults over 65 are nursing home or personal home care residents. Furthermore, Grandmother's cocktails are not cheering her up. Older adults who "self-medicate" with alcohol or prescription drugs are more likely to characterize themselves as lonely and to report lower life satisfaction. Tragically, many elders lose their “golden years” to alcoholism and chemical dependency, diseases that are very treatable.
The fact is that compared to a national average of from 15 to 20 percent for all other age groups, the recovery rate for older adults is an amazing 75 percent. And those of us who are working to address this hidden epidemic need others to understand that, contrary to popular perceptions, older adults are not simply a generation of has-beens, they are a generation about which much has yet to be discovered.
© Rabon Saip 2009
The Cost of Aging“We do not have elders because we have a human gift and modern capacity for keeping the weak alive; instead, we are human because we have elders."*
When I first read this statement several years ago, the depth and truth of it were not yet clear to me. But over time I understood that if it had not been for the first grandmother to sustain her daughter and help feed her grandchildren, we would not be here today. Without that primeval grandmother we would still be among many other two generation mammals struggling for survival.
For most of human history, the precedence set by the first grandmother has held that those who survived long enough to become elders had an important role in the community. Their long experience was the clay that held the culture together. It is a mistake to think that those elders were only valued as walking libraries, as repositories of information and skills now easily replaced by technological repositories. Wisdom cannot be so easily contained.
Today, with more elders than ever living among us, it seems ironic that their value has been so tragically diminished. We fail to recognize old age as a distinct and viable stage of life on its own. Most of us regard elders only as “adults” in a state of decline, an expensive collection of has-beens marking time in death’s waiting room. And, unfortunately, many of our elders feel the same way about themselves.
The fact is that old age is a stage of life about which little is actually known. We know of a few outstanding individuals from the past because not that many survived; but, as a separate stage of life, we are only now being challenged to understand and define this ambivalent period; a culmination of life that everyone dreads and yet hopes to achieve. Although there is sufficient evidence of positive aspects to aging (spiritual, psychological and emotional), this is grossly overshadowed by popularized negatives; as in the area of misguided humor.
The problem of substance abuse among elders must be understood as largely symptomatic of a yet deeper problem. As a society we go along with the commercially supported idea that aging is nothing more than a descent into illness and death, a tragic fall from the glowing perfection of youth. Although this idea is foundational to an economy that sells lots of anti-aging products, it also serves to undermine any hope of an integrated society - a society of balanced participation for all generations. In short, such ideas deny us all of our true potential.
We live in a world largely dominated by a cult of adulthood, a cult that corrupts the life course in both directions. The young are hurried to become adult and adults are encouraged to hang on to youth at all cost. Until we stop comparing youth to old age, seeing elders only as adults in decline, we will continue to feed the despair and hopelessness that ferments at the core of prescription drug and alcohol misuse among elders. And, self medicating against the painful indignity of a degrading decline will continue.
(*Reclaimed Powers by David Gutmann:1987)
© Rabon Saip 2010
Older Folks May Have Unhealthy Drinking HabitsBy Joene Hendry
Tue Mar 4, 2008 - NEW YORK (Reuters Health) - One out of every 10 Medicare beneficiaries aged 65 years and older may be drinking alcohol at levels deemed potentially unhealthy, researchers report.
"Risks of excessive alcohol use may include exacerbation of some medical problems, detrimental impact on functioning, risk of falls, and medication interactions," Dr. Elizabeth L. Merrick told Reuters Health. Older adults have a higher sensitivity and poorer ability to metabolize alcohol than younger adults, said Merrick, of Brandeis University in Waltham, Massachusetts.
People aged 65 years and older should drink no more than 7 alcoholic drinks a week and no more than 3 drinks on any single day, according to recommendations from the National Institute on Alcohol Abuse and Alcoholism and the American Geriatrics Society.
Merrick and colleagues found that most of the 12, 413 Medicare beneficiaries assessed for alcohol consumption through a 2003 Medicare survey reported drinking no more than recommended levels.
Overall, 65 percent of this predominately white, non-Hispanic, community-living group reported no alcohol consumption during a typical month in the previous year, while another 26 percent reported consumption within guideline levels, they report in the Journal of the American Geriatrics Society.
By contrast, 9 percent reported drinking in excess of 30 alcoholic drinks a month or 4 or more drinks in any single day in a typical month. Of these, 16 percent were men and 4 percent were women.
Merrick's team found that higher education and income levels, better health status, younger age, smoking, male gender, and being white was associated with "unhealthy" drinking, as was being divorced, separated, or single.
"At-risk or unhealthy drinking is often missed by health care and other providers," Merrick said. Also, older adults may not know that recommended limits are lower than those for younger people.
These findings provide current, generalisable information useful for targeted prevention messages, the investigators conclude.
SOURCE: Journal of the American Geriatrics Society, February 2008
Drinking and Alcoholism Among the Elderly
Between 1.1 and 2.3 million senior citizens use alcohol to deal with grief and loneliness. What has been called the "hidden population" is now being discovered and measured. Most people tend to reduce their alcohol intake as they get older, perhaps as a response to poor health or a change in social activities.
However, society has begun to recognize that the incidence of alcoholism among older persons is on the rise. And while it is difficult to find hard statistics on today's elderly alcoholics, as much as 10% to 15% of health problems in this population may be linked to alcoholism.
One fact is clear: alcohol-related problems among the elderly are much larger than perceived even a decade ago. It also is clear that the response remains devoted to treating their symptoms briefly and directly, rather than getting to the core of the drinking behavior and treating the alcoholism.
Studies indicate that there are three categories of elderly drinkers:
EARLY-ONSET drinkers are those who have a continuing problem with alcohol that began earlier in life.
LATE-ONSET or Reactors, begin drinking to excess in response to traumatic life events, such as loss of a loved one or difficulties in adjusting to retirement.
INTERMITTENT or Binge drinkers use alcohol irregularly but to excess.
Both Late-Onset and Intermittent drinkers have a higher chance of managing their dependency when they receive counseling and family support.
A family physician is often the first line of defense in determining whether or not an older patient is drinking too much. But all too often the problem goes undiagnosed or is underestimated. Perhaps the patient is in denial, or family members are too embarrassed to report alcohol problems to the patient's doctor. The diagnostic process is further complicated because alcohol abuse can be obscured by other health problems.
Many symptoms of alcoholism are problems usually related to aging: insomnia, depression and poor concentration. Some warning signs to look for are:
Confusion over simple things (date, surroundings)
Drinking small amounts of alcohol daily
Drinking at home alone instead of in social settings
Self-neglect or letting the home environment deteriorate
A pattern of falls and accidents at home
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How can you talk to an older person you suspect may have a problem with alcohol?
Don't bring up the subject when he or she is drinking. Be gentle and loving but be direct. Avoid words like "alcoholic" that are loaded with blame. Be specific by calling attention to a particular behavior (such as "I notice you drink nearly a whole bottle of wine each evening," instead of saying, "You are always drunk."). Let the person know you are worried about their drinking, how it may react with their prescription medications, and that you are willing to help them find treatment. Together, compile a list of all the prescribed and over-the-counter medications they take so their physician or counselor can fully evaluate the problem.
Tolerance to alcohol is significantly lowered as a person ages. It is important to know that many of the problems associated with drinking and the elderly are adverse side effects resulting from medication interactions with alcohol. Eighty-three percent of people over 65 take some prescription. More than half of all prescriptions for elders contain a sedative. Alcohol is a sedative that depresses brain function, as well as how medications are metabolized in the body. The action of some drugs is exaggerated, while other medications can actually increase the effects of alcohol. Alcohol taken together with antidepressants can worsen the depression.
How do you know if a person's drinking is alcoholism? "
Anytime drinking alcohol affects your health, then alcohol is a problem," says a professor of nursing. "Elderly alcoholics are more common than people realize or want to believe. "The good news is that seniors have a higher rate of recovery from substance abuse than many young adults. It is never too late to turn a life around.
Where to Seek Help -
AA for the Older Alcoholic: Never Too Late. Pamphlet published by Alcoholics Anonymous. Go to: www.aa.org or call your local A.A. office listed in telephone directory.