Yvonne Mirilovich came home from work one day in January 2016 and found her mother drunk while babysitting Yvonne’s two young daughters.
“I just lost it,” she said in a recent article in the Wall Street Journal.
“ I screamed at her. I called her a monster. She just stared at me with a blank face,” says Yvonne who is 39 and lives in Limerick, Pa. She told her mother, then 64, that she wanted her out of the house and not around her children.
That was when it finally sank in and her mother, Elaine Kurtz, faced the truth.
“What have I done?” Kurtz asked herself.
Substance abuse is rising among older adults, and their children are often at a loss about what to do. The number of Americans 65 and older abusing drugs and alcohol is expected to double to 5.7 million by 2020, according to the federal Substance Abuse and Mental Health Services Administration (SAMHSA).
Mrs. Kurtz’s experience, documented in a recent Wall Street Journal article, reminded me of a conversation I had with Dr. David Lipschitz at Little Rock’s University of Arkansas for Medical Sciences College of Medicine almost a decade ago.
When you get to be over 60, Dr. Lipschitz said in our interview, it might be best to skip the cocktails and other alcoholic beverages.
The benefits, he said, can be significant and the downside increasingly disagreeable.
Alcohol is the drug of choice followed by benzodiapines such as Valium for the over 60 crowd and its not so much about getting high but just wanting to feel better emotionally or physically.
“Substance-related disorders of all types remain overlooked in geriatric patients,” Dr. Lipschitz says, and by that he means overlooked by both the patients and the doctors who aren’t dealing with it as effectively as they might.
It’s not always easy to spot drinking problems in retired seniors, but they do have a way of showing up in emergency rooms in disproportionate numbers and in marital spats during the cocktail hour.
Indeed, one treatment center executive reports that spousal abuse is the leading cause of 911 calls emanating from a nearby upscale retirement community. And alcohol is almost always involved.
It’s a deadly serious issue, and Dr. Lipschitz wants seniors to get their share of attention and help.
Chronic abusers of alcohol, he said, may face: alcoholic cardiomyopathy or severe damage to the heart; psychiatric disorders, including Korsakov’s psychosis and destruction of intellectual functioning; damage to the cerebellum and spinal cord leading to weakness, severe leg pains and problems with gait and balance; cirrhosis; gastrointestinal bleeding; severe nutritional deficiencies; and bone marrow damage.
All of these ailments are painful to endure and most are potentially fatal.
Dr. Lipschitz described what one of his elderly patients was going through.
“I recently saw a patient who had significant memory loss, problems with gait and balance, a tremor and severe heart problems. His heart rhythm was irregular and cardiac catheterization done elsewhere showed that he did not have any coronary artery disease.
“The patient admitted to having 4 ounces of alcohol daily. However, his wife stated that he had that much by lunchtime and more during the rest of the day. Even worse, as he had gotten older, alcohol changed his personality and he readily became angry.
“Alcohol was killing this man and was the main cause of his memory loss, his inability to walk and his heart problems. Despite our pleas he continues to drink, completely denying that he has a problem.”
Alcoholism in the Elderly
One of Dr. Lipschitz’s major sources in his study of alcoholism is a scientific paper on “Alcoholism in the Elderly” written by Dr. James W. Campbell, a Cleveland geriatrics specialist who has spoken in Little Rock on the subject.
Campbell begins with a statement of the problem.
“Alcoholism is a high prevalence illness in older populations,” Dr. Campbell says, citing the fact that 14 percent of the senior citizens who show up in emergency rooms “have diagnosable alcoholism.”
He adds, “alcohol use significant enough to impair health is present in up to twenty percent of patients hospitalized on medical-surgical units.”
An interesting sidebar to his findings is that women get into the sauce just about as much as men. It’s just that the ladies haven’t been diagnosed.
“Older women represent the most under-diagnosed population,” Dr. Campbell says. “Twelve percent of older women drink to excess, and older women have a swifter progression to alcohol-related issues.”
So why are the elderly–both men and women–running into problems?
Part of it has to do with the season of life. The fact that they are getting on in years provides many with new reasons to drink and also greater opportunity.
Many seniors–women and men–do most of their drinking behind closed doors, and when they drink too much fewer people notice.
They are retired from their jobs, their kids are grown up and gone, they aren’t committing violent crimes, and except perhaps for an irate spouse, things are fairly quiet.
At the same time, there are new stresses–financial, health, loss–in their lives. The author of the phrase, “old age ain’t for sissies” knew what he was talking about.
Still every age has its stresses.
The main thing is physical change
What’s really at the heart of the matter are the physical changes the elderly are going through–changes in metabolism and in the body-fat-to-body-water ratio and reductions in the size of key organs like the liver and kidney.
The result is that a standard dose of alcohol produces a much higher blood alcohol concentration in an older person than a younger person of the same weight.
For physical reasons, they just can’t handle alcohol like they used to.
Okay, some will say, that’s understandable, but how about if I just cut back?
Maybe. But cutting back is hard to maintain, and, besides any quantity of alcohol could be harmful.
There is debate regarding the beneficial effects of low-dose drinking, and Dr. Campbell comes down on the side of abstinence.
“In younger persons,” he says, “low-dose controlled alcohol may improve cardiovascular risk factors. No clear evidence exists of benefits from drinking for elders. On the contrary, many diseases and medications used by the elderly have contraindications to alcohol use.”
Dr. Campbell adds that “Interactions between alcohol and prescription and over-the-counter (OTC) medications are potentially serious problems, especially in older persons.”
The best solution for the elderly is to quit.
Recovery is attainable
For most this will not be a problem. The alcoholic will find it more difficult, but combined with a message of hope, recovery is definitely attainable.
Furthermore, the physical and emotional damage the patients have sustained can often be arrested and in some cases reversed.
Seniors have an edge when it comes to getting well. Dr. Campbell says, “Alcoholism is treated successfully at all ages, and success rates are actually greater in older populations.”
The use of a screen to identify alcohol problems with patients in an emergency room followed by a brief intervention with family involvement and program of recovery such as Alcoholics Anonymous has been proven successful, Dr. Campbell says.
“The standard sobriety prescription includes these three steps: discontinue all substance abuse; attend 90 AA meetings in 90 days; and become active in a long-term program and attend meetings regularly.
Dr. Campbell continues, “AA is readily available and can be applied for any substance abuse disorder. Formal research on AA is by definition difficult; however, studies have shown attendance at 90 meetings in the first 90 days to be the most powerful predictor of long-term sobriety.
“AA is senior appropriate, and a third of all calls to AA are from persons over age 55. In contrast to classic theory a non judgmental approach without labeling appears to be more effective in older persons.”
This approach offers many positive benefits. Those who do abstain and attend 12-Step meetings often discover a host of new friends and healthier ways of dealing with life’s problems.
Other potentially fatal diseases don’t offer terms as attractive as these, many point out.
“If a doctor told a patient he could cure his pancreatic cancer by going to meetings and following a 12-Step program, he would jump at it,” one AA member observed.
Questionnaires screen patients
With regard to identifying the alcohol problem in patients, Dr. Campbell recommends two questionnaires, which have been used successfully.
The first consists of only four questions. One “yes” answer on the questionnaire indicates a probable problem.
The second–which has 24 questions–is the geriatric version of the Michigan Alcoholism Screening Test. Five or more “yes” answers suggest a problem.
Most of Dr. Campbell’s paper is concerned with alcohol and prescription drugs, but he also takes a cut at nicotine.
“Smoking,” Dr. Campbell says, “is still one of the most medically damaging substances. The Center of Medicare and Medicaid Studies is of the opinion that smoking is the single most preventable cause of illness.
“Over 10 percent of the population aged 65 years and over are smokers,” Dr Campbell says. “Specifically, 12.9 percent of persons aged 65 to 74 smoke and 6.1 percent of persons over age 75 smoke.”
Again, abstinence coupled with a program of recovery is the answer, he says.
“Smokers over age 65 are identified as the most likely to benefit from smoking cessation,” Dr. Campbell says, “and treatment based on brief intervention and 12-Step programs is effective in smoking and in all substance abuse disorders.”