One for the end of the road: alcoholism and drug abuse among the elderly
One for the end of the road: alcoholism and drug abuse among the elderly
The first few times 75-year-old Neville Barker dropped his meal tray, the nursing home staff passed it off as an accident typical of a frail old man with failing eyesight and hearing. Then one day an attendant smelled alcohol on Barker’s breath. An investigation soon revealed he had been consuming 13 ounces of rye whiskey daily since his admission two years earlier. Most of the “accidents” had occurred in the days following his walks to the bank to cash his monthly pension cheques. His only daughter later admitted he had started drinking heavily after his wife died of cancer nine years before and his failing vision forced him to give up even a hobbyist’s interest in his career as a cabinetmaker. To ensure his acceptance into the nursing home she had persuaded his doctor to omit a diagnosis of alcoholism from his medical report. In the interim, her visits had declined to once a month, and his only other living friend had been placed in an old-age home 300 miles away. Feeling useless and forgotten, he drank alone in a world of semidarkness and muffled sounds.
To Neville Barker, these are the promised “Golden Years,” a bitter irony he shares with more than 250,000 other Canadians over 55 for whom the only thing that sparkles any more is a liquid that dulls the pain of growing old. As a group, the elderly comprise less than 17% of Canada’s 23 million population, yet according to some estimates they account for almost one third of all problem drinkers. Between 5% and 10% of Canada’s four million men and women over 55 lead lives seriously disrupted by alcohol. A more accurate measure of their distress is the fact that from 1965 to 1973 deaths caused by cirrhosis of the liver leaped by 106% in men and 172% in women over 60. Nor does the problem stop at booze. U.S. Alcoholism and Drug Abuse Institute director Dr. Marc Schuckit recently estimated that one in 10 Americans over 60 is a probable abuser of legal drugs. Indeed, the elderly consume more prescription and over-the-counter drugs than any other age group. Last year about 44% of the sedatives prescribed by Canadian physicians in private practice were for patients over 55, along with 27% of drugs to combat anxiety and depression. Not surprisingly, researchers have found that more than three quarters of suicide attempts by the aged involve drugs obtained from their own doctors.
Despite such alarming statistics, the health and social problems caused by alcohol and drug abuse among the elderly have so far gone virtually unnoticed and un-
treated. Why is all too clear. To spare ourselves the pain of confronting our own mortality in old people, we isolate them in senior citizens’ ghettos, homes for the aged, and lonely rooming houses. Then, when many of them turn to alcohol or drugs to ease the loneliness and boredom we impose (or just to relieve the normal stresses of physiological aging), we look away. In doing so, we deny the problem exists and simultaneously reinforce our rejection of old age as a natural stage in human development.
Reckoning with the dependency problems of the elderly has acquired new urgency, however, and the ominous message comes from demographers. Thirty years from now the aged will double in size in relation to the rest of the population. Compounding sheer numbers will be the high rate of alcohol and drug use among those now in their thirties and forties. Unless we acknowledge the problem and begin to treat both its sufferers and its root causes,
say medical experts, we face the real possibility it will one day be society’s major drug problem.
Detecting the elderly abuser is hampered not only by his social isolation but by the attitudes of relatives and friends who commonly view alcohol and pills as the only “pleasures” left to the aged. “Many people refuse to see the suicidal behavior behind much of senile alcoholism,” says gerontologist and author Dr. Alex Comfort. “They don’t seem to think it matters if old people are hurting themselves.” He believes relatives actively encourage elderly family members to take depressants such as alcohol and Valium (a tranquilizer) to keep them quiet and out of the way. Another roadblock to recognition is a serious lack of medical and nursing home personnel trained in geriatrics. Depression, confusion, falls, and various physical complaints are routinely mistaken for signs of senility when they are, in fact, symptoms of alcohol or drug abuse. Some doctors frustrate treatment by dismissing both old age and alcoholism as “incurable.”
Despite studies which show a high rate of success treating elderly alcoholics, programs designed to meet their special needs are virtually nonexistent in Canada. Dr. Sarah Saunders, a medical consultant with the Addiction Research Foundation of Ontario, believes the continuing program she developed three years ago for alcoholics at Toronto’s Castleview-Wychwood home for the aged is the only exception. Some treatment centres will accept elderly patients into their regular program. But, says Saunders, many facilities have an unspoken cutoff point of 65. “They feel it’s not worthwhile to treat someone over that age, especially if resources are limited.” This attitude stems, in part, from a failure to realize that the older alcoholic is not necessarily a chronic, treatment-resistant drinker, but one who began drinking heavily late in life and whose behavior pattern can still be changed.
Old people, of course, tend to be sick more often than the rest of us, so it is to be expected that they will require more drugs. But their use of drugs is complicated by too many bad habits: a high degree of error in following prescription directions, the mixing of incompatible drugs, and the hoarding and sharing of medications. These factors, coupled with the older person’s lowered physical reserves and loose prescribing by physicians, do more than cause physical and psychiatric disturbances. They contribute to accidental or intentional overdoses. In one major hospital study of drug overdoses, four out of five patients over 50 had taken sedatives or minor tranquilizers to alleviate the commonest complaint of the elderly: sleeplessness. “In hospitals and nursing homes the overprescribing is surprising,” says Vancouver psychiatrist J. C. Morrant. Prescription charts may list up to 18 different medications for one patient. Furor therapeuticus, the term used by Morrant to describe the tendency of doctors to “medicate” the symptoms of aging, reflects, he says, “the physician’s guilt at being unable to cure the incurable.”
Attuned to the potential for abuse, medical authorities are now advising colleagues to halt prescriptions for sleeping pills, stimulants and anti-anxiety drugs for elderly patients except in rare circumstances. “Barbiturates,” says Morrant, “should go the way of bromides—into the dispensary trash can.” Although awareness of the problem is the first step toward resolving it, success ultimately rests on society’s ability to change fundamental attitudes toward the aged. “Most people don’t realize how intense is the pain felt by many old people,” says Saunders. “We must restore compassion to our treatment of them.” Neville Barker couldn’t possibly agree more. “You better just hope things change before you get to be my age,” he warns. “It’s no goddamn picnic being old now, I can tell you.” JUDY DOBBIE
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