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Senior substance abuse rises
Aging boomers expected to inflate numbers

by Sue Dremann

It's hard to picture a 94-year-old woman drinking herself to sleep every night, but that image is becoming an ever-increasing reality among seniors, according to Patrick Arbore, director of the Center for Elderly Suicide Prevention at the Institute on Aging, a San Francisco nonprofit that aids seniors.

On Nov. 2, Arbore spoke about seniors' substance abuse, one of the fastest-growing health problems among people 60 and older, at Stanford's Fairchild Auditorium. Stanford Health Library and Geriatric Health Services at Stanford University Medical Center sponsored the program.

Loneliness, ageism, grief, loss of status in society, physiological changes and chronic illness are driving factors in elderly substance abuse, Arbore said. Substance abuse currently affects an estimated 17 percent of older adults, according to a study by the National Institute on Drug Abuse. Alcohol abuse ranked highest, followed by prescription drugs such as sedatives, pain killers and anti-anxiety medications.

The trajectory is likely to rise, Arbore said. According to the U.S. Centers for Disease Control, between 1990 and 1998, there was a whopping 70-percent increase in diabetes in adults ages 30 to 39, leading to increased disabilities, such as blindness and circulatory problems.

Precipitously, an AARP study also concluded the estimated 77 million Baby Boomers will bring into aging more addiction due to fears of aging, high expectation for immediate solutions to health issues and increased loneliness due to multiple marriages and losing touch with children.

The medical and social infrastructure is far from being prepared, Arbore said. Few treatment programs are geared to seniors, who don't do well in mixed-age rehabilitation groups.

Senior substance abuse is the elephant in the room no one wants to discuss, he said.

"People don't know how to begin the conversation. Confronting an older person is not the thing to do. You may have to create a conversation, and it may have to happen many times. You have to be prepared for denial and not throw up your hands," he said.

Families often pass down unspoken messages about older people, he added.

"How did your family talk about Aunt Tillie -- how did they handle that she ended up sacked out in the bedroom from drinking too much at Thanksgiving?

"We often think we are doing the person a favor. Family members say 'Oh -- let her drink. She's had a hard life,'" he said.

But when a senior is passing out at 2 p.m., waking up late in the evening, having fitful sleep and getting up in the middle of the night to drink again, letting him or her drink is a far cry from an act of kindness, he added. Substance abuse leads to nutrient deficiencies, increased dementia, liver disease, cancer, cardiovascular problems and stroke, according to the American Medical Association.

The average senior over age 75 takes eight to 10 prescription medications, and alcohol can create a deadly cocktail. Woozy seniors are more prone to falls and accidents, breaking hips or arms, which leads to more drinking:

"They see it as the end of life. There is a fear of dependency, so they go home and drink," he said.

Seniors, especially people in their mid-80s, can quickly move into bereavement overload when many friends and family members die. Feelings of anger and abandonment by the life-mate who preceded them in death can become unmanageable, and a senior may turn to substance abuse to cope, he added.

Grief often extends to loss of familiar lifestyle, such as giving up a driver's license, retiring or losing status in a youth-oriented society, according to Arbore.

"One of the first things I noticed as I became older is that people look through you as if you don't exist," Arbore, 58, who sports a snow-white beard and hair, said.

"A woman once told me, 'I used to be somebody -- I'm no one now' -- as she sat there drinking from that bottle of wine. And she said, 'I'm thinking about killing myself.'"

More than one-third of suicides in older patients are alcohol-related, with recently bereaved elderly men having the highest rate of suicide and new alcoholism, according to a study by the National Center on Addiction and Substance Abuse.

Women are at particular risk for alcohol-related problems. Many experience more loneliness and depression as they age, and have a heightened response to over-the-counter medications and prescription drugs, the study noted.

Disability and mental problems are two large issues leading to substance abuse, Arbore said. Whether depression preceded substance abuse or is the result if it is hard to distinguish, he said. Compounding the problem, physiological changes in the elderly change metabolism of alcohol and drugs, and it takes far less to be affected, he added.

One standard drink a day, seven per week, or a maximum of two drinks on any occasion, with somewhat lower levels for women are the recommended levels of alcohol consumption for ages 60 and older, according to the Center on Substance Abuse Prevention.

A standard drink is defined as a 12-ounce can of beer, or a single shot of spirits, a five-ounce glass of wine, or four ounces of sherry or aperitif. But what constitutes "standard" in the mind of alcohol-abusing seniors can differ greatly.

When someone says he or she has only had one glass of wine a day, Arbore asks to see the glass.

"They'll bring out a goblet that is the equivalent of three standard drinks," he said.

Getting an elder to own-up to substance abuse can be difficult, but Arbore said family and friends should not give up. It often takes many conversations that may initially elicit a hostile response. Arbore recalled a patient who lay splayed across a table after taking a large amount of the antidepressant Xanax:

"I notice you've taken Xanax three times since I've been here," Arbore told the patient.

"Well -- now you know why," the patient responded. "It's because you are here and you annoy me, and my doctor says 'take as needed.'"

Researchers suggest family members avoid placing blame on the senior, but discuss risks and the potential for impairment, and keep responsibility squarely on the user. Speak in a nonjudgmental manner, with empathy, respect and understanding and offer optimistic empowerment.

Eventually, many seniors can be helped, Arbore said.

"One 98-year-old man said to his daughter, 'Quit your moaning. I quit drinking.'"

Staff Writer Sue Dremann can be e-mailed at sdremann@paweekly.com.