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Older adults face a sobering reality

Ed B. had already lost one wife. His first career had become derailed, and his second was on the rocks. Then he met the woman of his dreams. But she refused to marry him unless the drinking came to an end. It was the tipping point he needed. Rather than watch his life come crashing down again, Ed decided it was time to break the grip of the addiction that had had a hold on him for nearly 25 years. At the urging of a counselor and a physician, this Tampa resident reluctantly agreed to attend Alcoholics Anonymous. There, he recalls, he realized the toll alcohol had taken on his life: "I cannot control it. Whenever I drink, my life is going to be unmanageable," Ed B. says. That awakening came 11 years ago; now 67, he has been sober ever since. Ed B.'s story might seem the classic case — a long-term drinker whose life was spiraling out of control. But alcohol misuse among people older than 50 also can take much more subtle forms: the lonely widower who tucks into his gin and tonic every night for company, or the grandmother who stumbles and falls after taking her heart medication chased by two glasses of wine. The problem is forecast to balloon as the estimated 78-million boomers age and the population in general lives longer. (See the related column by Dr. David Lipschitz, Page 14.) Now, state and federal governments are working to tackle the problem, offering education for at-risk older adults, while also trying to train physicians about the warning signs. In many cases, these seniors "are remaining hidden abusers," says Larry Schonfeld, chairman of the department of aging and mental health at the University of South Florida.

Unlike younger people, who typically drink socially or even might get arrested for driving under the influence, older people often are retired and many live alone. Thus, Schonfeld says, "There's no one to say that their drinking is a problem."

Then there's the tendency for physicians to turn a blind eye, says Mary Lynn Ulrey, chief executive officer of the Drug Abuse Comprehensive Coordinating Office in Tampa. "Clinicians are slow to spot it, (perhaps) because it reminds them of their parents."

And some physicians aren't taught about substance abuse. Instead, they might diagnose and treat an older patient for high blood pressure but not question that person about other problems he or she has.

Last call

A federal study on alcohol use found that 12 percent of those age 55 and older drink heavily, and 5 percent binge, Schonfeld says.

One who fit that pattern is Mark M., a 58-year-old from Tampa. He says he started drinking in his teens and by his mid 20s was drinking each day. "I was a hard-charging young businessman and I really wanted to live up to that image."

By the time he was 30, Mark M. was drinking to excess almost daily.

"Happy hour was my thing." If there was a late afternoon business meeting, he'd make sure it was held at a bar, and if he was going to a social event where he knew there would be moderate drinking, he would have four or five double scotches beforehand.

He would even take medication that bore a warning label that said taking it and drinking to excess could induce seizures. He didn't care.

Mark M. first went to AA in 2004, but he wasn't ready to admit he had a problem. He stopped attending meetings and quickly fell back into his old ways.

Two years ago, he decided to rejoin AA and has been sober ever since. He sometimes thinks back on what his life had been like. "I wouldn't go back there for anything. I lived in a continual hangover, a continual fog."

Life change

Another one who is happy on her new path is Evelyn L., of St. Petersburg. She says she gave up alcohol after 25 years of drinking to excess to cover aches and pains.

Now 63, she said she was involved with a number of abusive men and suffered from bone fractures — due to both physical abuse and to osteoporosis. Evelyn said she would half fill a glass with water, then top if off with vodka. "I thought I was really cool and no one could tell I was drinking because it was vodka."

This attitude changed when she met Dorothy Chambers, manager of the Brief Intervention and Treatment for Elders, or BRITE, program, run by Gulf Coast Jewish Family Services.

Chambers asked Evelyn if she would cut back on her drinking.

"I had been thinking it really didn't taste good anymore,'' Evelyn relates, "but it did do a lot to alleviate a lot of my physical pains."

Nonetheless, she agreed she would try to stop.

That was two years ago, and not drinking has given her an "opportunity to get reacquainted with my own children, my own grandchildren, my own great-grandchildren," Evelyn says.

BRITE spots

Unlike Evelyn, who admits she used alcohol to self-medicate, others unwittingly exacerbate their problems by mixing medications and alcohol.

Chambers says something as simple as taking the heart medication digoxin and drinking three cocktails can double the effects of the alcohol. "They're just very unaware," Chambers says of some of the people with whom she deals.

Gulf Coast Jewish Family Services operated one of the trials for the BRITE program, which was launched in 2004 and financed by the state Department of Children and Families Substance Abuse Program Office.

Aimed at those 60 and older, the program was initially designed for people who misused alcohol, drugs and prescription medication.

Last year, the U.S. Department of Health and Human Services provided funding to teach physicians to identify patients who might have substance-abuse issues.

Since the trials, BRITE has expanded from three to 11 counties, including Pinellas, Hillsborough, Sarasota and Pasco.

Thus far, program manager Chambers has focused on educating Pinellas County residents who live in senior housing, receive Meals on Wheels or who seek similar help about potential risks of alcohol, prescription medication or drugs.

Screening for abuse

Last year, Gulf Coast Jewish Family Services screened nearly 300 people in the Tampa Bay area, and 33 were admitted into the BRITE program.

"A lot of people who screen positive don't want services," Chambers says. The program staff does two to 16 educational sessions for those who are at risk and can refer these people to other organizations or programs for further assistance.

With the BRITE program, internists and general practitioners are given six questions to use to help detect substance abuse by those age 60 and older. The questions focus on topics such as whether the person drinks more than a certain number of drinks each day, or if they have ever forgotten to take their medications.

"Because there is such a stigma, you don't want to put them (patients) off with hard questions," says Ulrey, CEO of the Tampa drug-abuse office. If the answers raise red flags, more screening is done.

Even if a problem is detected, not drinking doesn't mean an end to having fun. Evelyn says she still breaks out her cocktail glasses at cocktail time, and offers up soda, juice or water to friends. She explains:

"I've got all these beautiful glasses. Why not use them?"

Susan Ladika is a freelance writer living in Tampa.

Editor's note: Individuals who had abused alcohol agreed to be quoted only if their last names were withheld, to protect their privacy.

Older adults face a sobering reality 06/23/08 [Last modified: Wednesday, June 25, 2008 11:31am]
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