Loneliness and depression are driving the elderly in Canada to increasing the size and number of drinks....You can motivate a young adult to give up drinking by pointing to a future that holds the possibility of a stable job, family and holidays. These high points do not necessarily work for a 70-year-old. ....

The elderly in Canada are hitting the bottle in a big way. Social workers say loneliness and depression are driving the elderly to increasing the size and number of drinks, and the stigma of alcohol abuse in old age keeps the problem under wraps. Meanwhile, alcohol abuse among seniors continues to grow. "Many depressed older adults slide into a suicidal state as they become careless about their drinking," says Margaret Flower, clinical coordinator of geriatric psychiatry at the Toronto-based Centre for Addiction and Mental Health, a teaching hospital. She says often the elderly drink themselves to death. "So what gets recorded as a heart attack is often a direct result of deliberate excessive drinking leading to a hasty demise."

And getting help on time also becomes difficult because visiting family members are more likely to attribute the increasingly frail and disoriented state of the elderly to age than to alcohol abuse. Consider the statistics that sum up this gloomy picture. According to the 2004 Canadian Addictions Survey, sponsored by government health agency Health Canada and a number of provincial addiction centres, the elderly drink more than any other age group. Among older adults (aged 75 or older), 24.2 per cent drink four or more times a week. Only 3.4 per cent of younger people (20-24) drink as much in a week. When a septuagenarian — already taking a variety of medicines — downs after-dinner glasses of sherry and whiskey, the cocktail is often too strong for his/her fragile metabolism. Pharmacists agree that older adults are their most important patient group. "Although they comprise only 12 per cent of the population, they take between 20 and 40 per cent of all prescription medication," says Kelly Babcock, President of the Canadian Society for Hospital Pharmacists, a national voluntary organisation of pharmacists. "In many cases, seniors don't know that the medication they are taking for a chronic pain or blood pressure should not be mixed with alcohol," says Flower.

Late-onset problem drinkers


In other cases, elderly social drinkers reach for the bottle because of a major life crisis. Social workers call such cases late-onset problem drinkers. Betty Macgregor, Manager of the Ottawa-based Lifestyle Enrichment for Senior Adults programme (LESA), which offers help to seniors with addiction and gambling problems, draws a picture of the archetypal late-onset drinker. "She would be a lonely 75-year-old whose husband died recently, and who now lives on her own, away from busy children. She would be suffering from growing loneliness that threatens to pull her into depression." She would be taking medications for something as common as arthritis and would start taking occasional drinks to deal with loneliness. "The combination of medicine and alcohol would soon become a problem and the case would be referred to us." Most cases reach the LESA programme through concerned family members, physicians or health workers who come in direct contact with the elderly and suspect addiction problems. Next, LESA counsellors visit the elderly in their homes to assess the intensity of alcohol abuse and provide counselling. "In most cases, late-onset drinkers don't know what is happening to them. They are told how alcohol is playing havoc with their metabolism and are motivated to make a change," says Macgregor.

This requires a special set of strategies. "You can motivate a young adult to give up drinking by pointing to a future that holds the possibility of a stable job, family and holidays. These high points do not necessarily work for a 70-year-old," says Flower. So, instead of the future, the elderly are reminded of their rich past, full of experiences and memories. These are used as confidence boosters to help them rise above alcohol abuse. The bottom line, counsellors say, is to provide non-judgmental care to the elderly. "If it is a case of medications mixing with alcohol and doing harm, we don't mention alcohol and talk about the medication instead," explains Flower. The elderly are encouraged to follow a good healthy diet that could reduce dependence on medication and, after sometime, the stress is shifted to how alcohol is increasing the problem. However, there are many problems with helping older adults, and none of this is a cakewalk.

Counsellors agree that they have to work with seniors who often feel a great deal of shame about their drinking problem. "The women have grown up with a mindset of `ladies do not drink'. So they feel a great deal of shame and guilt, and try to hide their drinking," says Flower. Often, by the time the case reaches the counsellor, the abuse is far progressed. This is because physicians do not look out for the subtle signs of alcohol abuse in senior women. The incorrect stereotypical image of someone with an alcohol abuse problem, counsellors say, is of a middle-aged male — a far cry from the typical Mrs Todd, all calm and collected on the surface. Early-onset drinkers are, perhaps, the greatest challenge. They have had a problem with drinking most of their lives because of which they are often alienated from family members who are loath to help them out. "Two-third of the older adults with a drinking problem developed the problem early in life," says Macgregor.

Health impairment


Medical conditions also make it more difficult to help the elderly. Long-term alcohol use can cause cognitive impairment — a memory disorder. It can also damage the frontal lobe, an area of the brain responsible for making and carrying out decisions. If this happens, even when the counsellors put the seniors on medication, they find it hard to remember to take it on time. "If the cognitive impairment is minor, we send reminders to seniors to take their medication on time. If it is far progressed, they do not even remember when they are drinking," says Macgregor. In such cases, either family members or full-time caretakers are involved in the process of recovery. Stressing that drinking is often the symptom of a larger problem, Flower says, "Depression is a very big problem with the elderly and often this leads them to alcohol abuse. However, facts like these never come to light with the elderly being ignored."