Sunday, April 26, 2015

The Alcoholism That May Be Overlooked

Alcoholism is no joke and the seriousness of the problem can only be appreciated once you begin to look at some of the statistics.  And, of course, don't forget the ancillary problems wrought by imbibing too much of the grape and the mash over a lifetime. I'm speaking, naturally, about the increased risk of liver and kidney disease, brain damage (think Korsakoff's), immune system dysfunction and cardiac conditions. Korsakoff's alone is a terribly disabling condition that is often confused with a garden-variety psychiatric disorder, unless a truthful interview is carefully performed by a knowledgable professional.

Most persons with a history of alcohol abuse won't be forthcoming in their interviews and I recall being told by a psychiatric supervisor that whatever the person responds when asked how much they drink, multiply it by four. I took that advice with a grain of salt and I soon learned to phrase my questioning to ferret out those who would tell me, "Oh, I have an occasional glass of wine with dinner." The actual truth, in one woman's case, was that she had a bottle of wine with dinner and then, of course, after dinner drinks and a gallon of wine was in the garage--"for emergencies." What type of emergency would require a gallon of wine? Odd thing to say.

On a recent trip to Florida, I made the entirely unscientific observation that there was an inordinate number of front-of-store displays of wine. Bottles of wine were in the "two-for-one" displays category and I wondered why. Then I began to look at the grocery carts being wheeled about by older couples and soon discovered either gallon jugs or multiple bottles of various wines. Hmmm, I thought, looks like there's a bit of tippling going on here.  Was it just celebrating the season, having guests over or a sign of something else?

My observations were soon solidified when I read an article in the local newspaper that centered around the increasing abuse of alcohol in the "affluent" elderly population. Were the elderly in this area truly "affluent" or were the stats skewed and poorly computed? Couldn't tell because, after all, it was a newspaper article and not a reviewed professional journal. The journal would have been very specific regarding how the statistics were collected and would have provided info on the group studied. Okay, if the group were elderly and affluent, then the article was right on target.

However the groups had been selected, my experiences in the super market with the displays and the alcohol in the carts, would seem to point to more drinking in this population but I would have to compare it to elderly in other areas. Couldn't do it.

This surge in alcohol consumption has, by some, been deemed a hidden group of persons undiagnosed with alcoholism. In that sense, it is probably like the former "kitchen sink drunk" syndrome we read about a few decades ago. Housewives, when women were expected to remain in the home and not have careers, were tippling in their kitchens and it wasn't only the cooking sherry, although it might have started there.

Women, according to the National Institute on Alcohol and Alcoholism, are at greater risk to suffer from alcohol addiction.  Partly a function of metabolism and, perhaps, the internal/external pressure to meet societal expectations, this tendency toward abuse stands as a warning for women. But what about older women? Remember we saw that article that stated alcohol use is hitting an upswing in certain Southern U.S. climes? When the kidneys don't work as they once did and the liver is assaulted, to use one term, by multiple prescription medications for illnesses in advanced age, it would seem older women are at greater risk.  Then, too, there's the difficulty of widowhood.

Mixing alcohol with many prescription medications with decreased liver clearance and you have now increased risk for medical consequences in addition to alcohol impairment. A bit of prescription antidepressants or even other meds can bring on the fisticuffs in the liver and the result is higher levels of alcohol. Depends on which substance gets to the receptors in the liver first and hangs on there.

Booze is probably the only non-prescription "medication" available for those who are anxious, have social anxiety disorder in general or are so stressed by life's trials that relief is needed.  Sure, some physicians even prescribe one drink with dinner. Yes, I've seen the scripts written in upscale nursing homes where the liquor was kept in a locked cabinet at the nursing station.

One statistic notes that "9% of Medicare beneficiaries (age 65 and older) drink more than 30 drinks a month and more than 4 drinks on any one occasion."  How close to becoming an addicted person does that place them? Pretty close and certainly uncomfortably close to environmental dangers, including driving and walking up or down stairs.

Considering how inefficiently alcohol is metabolized in the older adult's body, this can contribute to one of the most significant problems in aging--falls. Check the stats on falls and how well people recover or don't once they're of an advanced age, and it can be eyeopening. Some will go to physical rehab where, hopefully, their alcohol abuse will be discovered, but not all will recover so quickly. For some it will be a downward spiral from which they will never recover. Not a bright picture there.

The experts are in agreement here. "Aging lowers the body’s tolerance for alcohol, and older adults can develop problems with alcohol even though their drinking habits haven’t changed. Older adults can experience the effects of alcohol, such as slurred speech and lack of coordination, more quickly than when they were younger,” says Kenneth R. Warren, Ph.D., acting director of the NIH’s National Institute on Alcohol Abuse and Alcoholism (NIAAA), which developed the topic. “If you’re older and you drink, it is important to understand the implications this may have for your health, safety, relationships and lifestyle. The newest topic on NIHSeniorHealth provides an excellent overview of these issues in a format that is tailored for older adults.”

Disturbingly, some statistics point to 49% of admissions for elderly to nursing homes have a problem with alcohol abuse. In just three years, an estimated $100 billion will be spent on adults who have problems with alcohol. When you consider that we are facing a significant uptick in senior citizens in less than half a decade, the situation is more than dire. 

Where do we go from here? For starters, what is the reason for all this drinking in seniors? Are we neglecting some aspect of their lives, devaluing them in society, being less-than-helpful in their future prospects or some hidden factor? We need to explore all of this and it needs to be done pronto. In a world that is increasingly ageist and millenial-focused, we are marginalizing our seniors and failing to appreciate how they can contribute to all of us. Neglect them and you can face a sorry future for yourself. Count on it.

Are senior citizen complexes or "retirement communities" providing an answer? I doubt it. I recall hearing a woman, who lived in an upscale senior citizen development, say, "I don't want funerals to be my primary social event of the month." Parsing out the whole spectrum of the community and segregating the elderly actually results in one version of a ghetto, in my humble opinion.  

Refusing residents the right to have pets or small dogs is another way we take the joy from the lives of our elderly. Restricting residence to only those over 55 automatically thrusts the entire community into a certain mindset that may not be beneficial for everyone.  Alcohol appears to be providing some relief for too many of the residents.

Who are the elderly in your life and where are they right now?

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