Portrait in a glass
Retired teacher Joanne Smith to all outward appearances had always lived a “normal” life. Married 40 years (husband Joe died 10 years ago), mother of two successful children now living far away, her world was not at all what it seemed to be. Smith (not her real name) was, in fact, harbouring a secret “lover” – alcohol – and she had become an expert at deception.
Smith’s drinking, always heavy, escalated dramatically after her husband’s death, and gradually she began to drop all her favourite activities – yoga class, the symphony, even telephone chats and outings with best friends.
“I put it down to older age, a change in preferences, never a drinking problem,” says the still-attractive 70-year-old. “Even when my friends and children confronted me, I denied everything… said a few drinks just got me through the rough, lonely spots. I was kidding myself.”
Smith’s rampant alcohol consumption continued, astonishingly enough, throughout her recovery from a hip fracture, even a mild stroke. Happily, she sought and received counselling and is enjoying life again – stone cold sober.
Isolation and other factors
Triggering Smith’s abuse wasomething that knows no socio-economic boundary and partially explains why over 40 per cent of Canada’s senior citizens are regular drinkers. In fact, the 1997 Canadian Profile on Alcohol, Tobacco and Other Drugs reported that 64.3 per cent of those aged 55 to 64 currently drink, as do 54.8 per cent of seniors aged 65 to 74, and 46.2 per cent of those over 75.
Loneliness, the loss of one’s purpose in life after retirement, the death of loved ones, declines in financial status and connections within the community, as well as chronic pain and age-related health problems make alcohol abuse (clearly the #1 substance of choice for the elderly, followed by self-medicated use of prescription sedatives and over-the-counter products like Tylenol) a different, multi-layered issue for seniors than for the general population.
As the projected number of seniors (which Statistics Canada currently estimates to be 12 per cent of the population) booms from six million (16 per cent) in 2016 to 10 million (23 per cent) by the year 2041, the diseases exacerbated by prolonged substance abuse – arthritis, rheumatism, high blood pressure, diabetes, heart disease, dementia etc. – and the escalating burdens thrust upon the healthcare system loom very large.
Seniors not the focus
“Canada spends $110 million on addiction programs, but only half of one per cent is dedicated to the treatment of seniors. Of the 180 addiction programs funded by Ontario’s Ministry of Health, only two are specifically designed for seniors and most are done on an out-patient basis,” explains Phil Moorman, Program Manager for Ottawa’s Lifestyle Enrichment for Senior Adults program (LESA). Moorman says between $23 million and $1 billion is spent on seniors who enter hospitals with alcohol-related injuries such as hip fractures.
In its 1994 issue, Health Reports estimated that by the year 2013 there would be approximately 49,000 hospital admissions and 1.5 million days associated with fractures of the femur – twice the number of 1990. If Statistics Canada’s current cost per capita on hospital admissions of $759 holds true, it’s clear that senior treatment programs can contribute enormously to reducing the fracture incidence among the elderly, saving untold dollars for Canada’s healthcare system.
Baby boomers more at risk
Moreover, Dr. David Evans, Medical Coordinator for the Victoria Innovative Seniors Treatment Agency (VISTA), says that current epidemiological research indicates baby boomers – those born between 1947 and 1965 – use alcohol and drugs more pervasively than today’s 65-plus generation. “In the future, seniors will have abuse problems in a very different continuum, where more marijuana and illicit drug use will carry over from youth into old age. For healthcare service agencies to ignore this fact is very short sighted.”
“No one intentionally sets out to become addicted,” says Eileen McKee, Director of Toronto’s Community Older Persons Alcohol Program (COPA), Canada’s first seniors-only, community-based treatment service, launched in 1982 by the Addiction Research Foundation. “What started out as youthful drinking becomes a 40- or 50-year-long habit.
Whether the situation occurs with an older person living in a boarding house or a mansion, the common thread is the same – an addiction replaces something missing in their lives.”
Just as the “whys” behind seniors’ substance abuse are unique, the recovery treatment they require also differs from the traditional models used to rehabilitate those under 40, where abstinence is primarily advocated. This difference, as McKee explains, became apparent to Dr. Sarah Saunders, COPA’s founder. In 1969 she was asked to respond to the disruptive drunkenness of older men in Toronto residential settings. Toronto’s Addiction Research Library – widely regarded one of the best libraries on addiction issues in the world – had no literature concerning the treatment of seniors, so Saunders put her own observations into practice. After several months she began seeing improvements in these residents that could be duplicated in other settings.
“Traditional treatment required that a person admit their alcohol problem and abstain before they entered a clinic or rehabilitation program,” says McKee. “Dr. Saunders discovered that seniors could not – and, in many cases, would not – do this. Treating seniors who had abused or misused alcohol meant working with people in denial and who, through physical impairment or stubbornness, would not seek assistance. Help had to come to them.”
Moreover, she discovered that harm reduction, or continued moderate substance use, achieved greater results than did abstinence.
“This was quite a heretical idea at that time and is still considered by some to be controversial,” says McKee. “But it works and it’s what makes COPA unique. We’ll take the rejects from other programs and work with them. If we help cut their drinking in half; give proper counselling services and medical support; provide realistic tools to solve individual problems; and integrate them back into the community, then we consider that a success.”
Next page: Negatively impacts on memory
According to VISTA’s Dr. Evans, this senior-therapy counselling and case management approach has become the state-of-the-art model now used by other programs across Canada. “There are two groups of seniors we’re dealing with: those who have used alcohol most of their adult life, and the one-third of the senior population that develops a substance abuse later on,” he explains, adding that half of all alcohol-related deaths in British Columbia alone currently occur in the senior population.
Like COPA, VISTA creates a personalized plan of attack for each client that holistically combines social work, counselling and psychiatric/medical services to socialize people back into the community. As Dr. Evans says, “Many seniors become more amenable to counselling through this model. It helps them reconnect within a social network and stay sober at the same time.”
The process is straightforward. As Arlene Weaver, VISTA’s hospital liaison, explains, “Many seniors come to our attention in hospital after being admitted for hip fractures or other problems that can be linked to alcohol abuse. If there’s a willingness for outreach, we’ll go to their home and assess the situation, looking closely at health factors, financial circumstances, and the quality of family relationships. We work with what we’ve got, determine the individual’s needs, and start moving forward. Even if there are setbacks – and there often are – each one is looked at as an opportunity for change.”
Takes time to create change
However, progress is neither swift nor easy. “This type of treatment involves building trust with each client. It’s a slow approach,” says Weaver. LESA’s Moorman concurs. “Seniors with addictions have a complex history and gobble up time, taking on average between nine- and 18 months of counselling,” he says. “Detox, which seniors prefer to do at home, not a clinic, takes up to one week. That’s the easy part. The real challenge is in helping them cope with the ongoing need to drink.”
Not surprisingly, the physical consequences are greater for seniors who chronically abuse alcohol. In 1998, Statistics Canada’s Health Reports revealed that 10 per cent of Canadians aged 65 to 75 and 13 per cent of those aged 75-plus were multiple medication users. “Seniors are prone to heart disease, liver failure, suicide, depression, and cognitive impairment plus are likely to be on one or several medications to address these problems. Alcohol clearly interacts with other medications in a dangerous way,” says Dr. Evans.
For example, in 1997, Canadian Trends reported that eight per cent of Canadians over 64 suffer from various forms of dementia (including 2.4 per cent of seniors 65 to 74, 11 per cent of those aged 75 to 84, and 35 per cent of those over 84) and that women made up 68 per cent of this entire group. Take that one area of illness alone, combine it with uncontrolled drinking, and the beginning of a downward spiral in an elderly person’s health isn’t hard to comprehend.
Alcohol’s negative effects upon memory, decrease in judgment, or ability to learn new things continues even after an elderly patient has been sober for a while, primarily because they have less body mass than their younger counterparts and, as a result, metabolize alcohol very differently. “A standard drink is one bottle of beer, a 1.4 oz. glass of wine, or 1 oz. of spirits,” explains Lise Therrien, Director of Groupe Harmonie, Montreal’s only senior-specific treatment program. Generally senior men and women react very differently to alcohol. Different sexes, different approaches
Because of aging body tissue, senior women are more sensitive to alcohol’s effects. Those suffering from osteoporosis put themselves at double jeopardy if they drink. Also, reduced mental and physical health can leave women completely unable to live independently and can result in premature disability or death.
How women and men drink also differs. Having come through World War II, many men head to the Legion Hall or the local bar to drink as a means of socializing. But many senior women feel a stigma attached to drinking in public, so their alcohol abuse takes place at home. As LESA’s Moorman says, “There’s a kind of sexism out there. If someone fought a war, why should he be denied booze? So the female problem often gets shuffled under many other problems, if it’s even addressed at all.”
He adds, “The geriatrics field itself has only been around for 15 years. And, Canadian medical schools only added addiction studies into their curriculums within the last six years. This area of study is still relatively new, making it very difficult to find specialized treatment for seniors, especially in remote areas.”
Ultimately the signs of substance abuse are quite clear. According to Christine Bois, Director of the Centre for Addiction and Mental Health in Ottawa, first consider the quantity of alcohol being consumed. “Adults are allotted 12 drinks a week, or roughly two alcoholic beverages per day. Seniors, however, can have eight drinks per week and certainly not all in one day,” says Bois. A yellowish colour to skin may indicate alcohol impairment to the liver. Dizziness, trouble concentrating, or the inability to sleep may also be signs of a drug/alcohol interaction. Finally, personal losses or withdrawal by choice from friends or family may also reflect alcohol’s numbing negative effects.
As Groupe Harmonie’s Therrien sums up, “Loving care is the key in senior programs. By providing sensitive treatment and discovering what’s behind the alcohol abuse, we can work with people and give them the power to change.”