Senior drinking, drug abuse often missed

CLEVELAND, Jul 16, 2003 (United Press International via COMTEX) -- When Jack Nicholson's newly retired, newly widowed character descended into an alcoholic stupor in the movie "About Schmidt," the performance earned the veteran actor an Academy Award nomination.

For thousands of Schmidt-like seniors who are admitted to alcohol treatment centers, however, no Oscars are waiting. Just four to six weeks of intensive care to help them back on the road to sobriety.

The truth, treatment experts told United Press International, is age offers no immunity to either alcoholism or drug abuse. Relatively few seniors make it to treatment programs because physicians generally fail to diagnose substance abuse when the patient is a senior citizen.

That lack of recognition is feeding a problem that Carol Colleran calls "America's hidden epidemic."

Colleran, national director of older adult services at Hanley-Hazelden, a treatment center in West Palm Beach, Fla., told UPI as many as 17 percent of Americans age 55 or older harbor alcohol or drug problems. In many cases, seniors struggle with both addictions.

In the 1970s, addiction experts wrote in scholarly journals if a person was not an addict or alcoholic by age 45, he or she would never become one. But more recently researchers in addiction medicine have recognized addiction is a lifelong health risk.

About two-thirds of older alcoholics "actually have early onset alcoholism, meaning before age 50," Colleran said. "These people always had problems, but often (they) experienced many productive years in which they held down jobs and raised families." The remaining one-third developed late onset addictions, often triggered by a life change such as retirement or death or disability of a spouse.

"Our patients often tell me that their whole lives are about loss -- they are losing their hair, hearing, teeth and eyesight and then they lose loved ones and friends," Colleran said. Sometimes these late onset alcoholics are misdiagnosed with depression. "But once we get them through detox, the alcohol induced depression lifts and we can confirm that alcohol is the real problem," she said.

According to the National Institute on Alcohol Abuse and Alcoholism in Bethesda, Md., 6 percent to 11 percent of older Americans admitted to hospitals exhibit symptoms of alcoholism, as do 20 percent of elderly patients in psychiatric wards and 14 percent of elderly patients in emergency rooms. Moreover, the NIAAA reports, elderly admissions for alcohol-related problems roughly equal admissions for heart attacks, but physicians and nurses are "significantly less likely to recognize alcoholism in an older patient than in a younger patient," an NIAAA Alcohol Alert states.

Kristine Pringle, a doctoral student at Penn State University's school of health policy and administration in University Park, Pa., said Medicare records support this pattern of under-diagnosis. Pringle and a colleague, Dr. Dennis Shea, professor of health policy and administration, analyzed data from Medicare's Current Beneficiary Survey to determine how often doctors diagnose alcoholism in their elderly patients. Then they compared the diagnosis rate to the results from a national survey of elderly retirees who were asked several health questions, including questions about alcohol abuse.

When older Americans are asked about drinking, Pringle said, a little over 4 percent admitted they had drinking problems. According to Medicare records, however, the diagnosis rate for alcoholism is about 2 percent. "So, doctors are only diagnosing about half of the alcoholics in the Medicare population," she said.

Pringle's study also found wealthier elderly patients are more likely to be diagnosed than the elderly poor -- an interesting finding because both rich and poor seniors are covered by Medicare, so access to care does not seem to be a determining factor.

Colleran said the diagnosis rate probably is a lot lower than the 50 percent reported by Pringle. "Several years ago we did a study with researchers at Columbia University," she said. "We interviewed 400 physicians and tested them with a hypothetical case study of an elderly alcoholic. Less than 1 percent of them mentioned alcohol.

Among the elderly "when you see a shaky hand or short term memory loss, most people -- including doctors -- don't think alcoholism," Colleran noted. "It is really difficult to confront a sweet, white-haired woman and tell her that you think she has a drinking problem."

The prevalence of alcohol problems among seniors should not be surprising, however, Colleran said, because much of the good life of retirement is a set-up for alcohol problems. "Retirement communities are hot beds of alcoholism because the entire social life revolves around drinking," she explained.

For example, the typical day at many Florida retirement communities starts with drinks around the pool, continues into happy hour and then settles down for an evening of drinking at a resident's home. Many times, family members are unaware of this daily cycle because they live far away from retired parents or grandparents. Or, Colleran said, in an all-too-common reaction, relatives develop a hands-off approach because elderly drinkers "deserve to have a good time. But what happens is that as the drinking escalates there are no good times to be had."

Colleran said diagnosis is easier when family and friends are aware of the warning signs of alcohol abuse.

"Unlike younger alcoholics, the warning signs are not likely to be financial or legal," she said. Signs to look for include "bumps and bruises from falls," a decline in personal hygiene and "difficulties in relationships with family members or friends." Also, if an elderly person is purchasing large quantities of Nyquil or Listerine, that's a red flag because both have very high alcohol contents and a trip to the drug store is much cheaper than a trip to the liquor store.

As difficult as it is to diagnose alcohol abuse in the elderly, Colleran said drug abuse is even more challenging. Although older Americans rarely use street drugs, the rate of prescription drug abuse is very high, she said.

"The most common addiction is to benzodiazepines -- tranquilizer drugs like Valium and Xanax," Colleran said. "Valium was developed as post-trauma medication to be used for 14 days ... We have patients who have been taking it for 20 to 25 years." She said most of the patients do not consider themselves addicts because "the doctor prescribed it." Also, older patients tend to consider addictions a moral rather than medical problem and they associate terms such as "addict" and "alcoholic" with shame.

"They will see a recovering heroin addict and say, 'that person is a drug addict, not me,'" she said. "And to many of these people, a alcoholic is the drunk under the bridge."

Once the initial denial is overcome, elderly substance abusers do as well -- and in many cases better -- than younger addicts and alcoholics, Colleran explained. Typical elderly patients require "four to six weeks of inpatient care for treatment of either drug addiction or alcoholism." On discharge, many treatment centers follow-up with "alumni" programs, or they direct former patients to community-based, 12-step recovery programs such as Alcoholics Anonymous.

Diagnosis is important, but Colleran said prevention should not be overlooked. Because alcohol consumption often takes off at retirement, she suggested Americans change the approach to their retirement planning.

"We always hear about financial planning for retirement," she said. "But I think that emotional planning is just as important. We need to plan for ways to retain our sense of belonging and being needed by others. An emotional retirement plan could go a long ways toward preventing alcoholism and drug addiction among the elderly."

Copyright 2003 by United Press International.