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OLDER ADULTS AND ALCOHOL PROBLEMS

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Title: OLDER ADULTS AND ALCOHOL PROBLEMS


1
OLDER ADULTS AND ALCOHOL PROBLEMS
  • Kristen L. Barry, Ph.D.
  • Research Associate Professor
  • University of Michigan Department of Psychiatry,
    and
  • Associate Director, Department of Veterans
    Affairs National Serious Mental Illness Treatment
    Research and Evaluation Center (SMITREC)

2
Outline
  • Prevalence
  • Drinking Guidelines
  • Issues Unique to Older Adults
  • Co-morbid Medical and Psychiatric Conditions
  • Screening and Detection
  • Prevention, Brief Alcohol Intervention and
    Treatment
  • Summary and Recommendations

3
Prevalence
  • Prevalence depends on definition of at-risk or
    problem drinking 1-15 of older adults are at
    risk or problem drinkers
  • Prevalence differs with sampling approach
  • Alcohol use problems are most common substance
    issue for older adults, but confounded with
    prescription, herbal, and over-the-counter
    medications

4
Prevalence (cont.)
  • Older adults with alcohol use problems are not
    recognized by many professionals
  • Few older adults with alcohol abuse or dependence
    seek help in specialized addiction treatment
    settings

5
Drinking Guidelines
  • Should not exceed 1 drink per day
  • Never more than 2-3 drinks on any drinking day
    (binge drinking)
  • Limits for older women should be somewhat less
    than for older men
  • (NIAAA, 1995 DuFour Fuller, 1995)

6
Drinking Guidelines (cont.)
  • Recommendations consistent with data on
    benefits/risks of drinking in this age group
  • Lower limits for older adults because
  • increased alcohol sensitivity with age
  • Greater use of contraindicated medications
  • Less efficient liver metabolism
  • Less body mass/fat increases circulating levels

7
Defining Alcohol Use Patterns
  • Abstinence no alcohol for past year
  • Low risk use alcohol with no problems
  • At-risk alcohol use with increased chance of
    problems/complications
  • Problem drinking experiencing adverse
    consequences
  • Dependent loss of control, drinking despite
    problems, physiological symptoms (tolerance,
    withdrawal)

8
Alcohol Use Patterns (cont.)
9
Older Adults Alcohol Use
  • Increased risk of stroke (with overuse)
  • Impaired motor skills (e.g., driving) at low
    level use
  • Increased risk of injury (falls, accidents)
  • May result in sleep disorders
  • Increased risk of suicide
  • Interacts with dementia symptoms

10
Older Adults Use (cont.)
  • Higher blood alcohol concentrations (BAC) from
    dose
  • More impairment from a BAC
  • Potential interactions/increased side effects
    with medications and/or compromised metabolizing
    (especially psychoactive medications,
    benzodiazepines, barbiturates, antidepressants
    digoxin, warfarin)

11
Social Work Screening
  • Who?
  • Every person aged 60 or over
  • If physical signs are present
  • Undergoing major life changes
  • What?
  • Screen for alcohol and prescription drug
    use/abuse
  • How?
  • In any regular services
  • Brown bag approach
  • Ask direct questions
  • Avoid stigmatizing terms

12
General Issues for Older Adults
  • Loss (status, people, vocation, health, etc.)
  • Social isolation, loneliness
  • Major financial problems
  • Housing changes
  • Family concerns
  • Time management burden
  • Complex medical issues
  • Multiple medications
  • Sensory deficits
  • Reduced mobility
  • Cognitive impairments
  • Impaired self-care, loss of independence

13
Potential Alcohol Problems in Older Adults Signs
  • Anxiety, depression, excessive mood swings
  • Blackouts, dizziness, idiopathic seizures
  • Disorientation
  • Falls, bruises, burns
  • Headaches
  • Incontinence
  • Memory loss
  • Unusual response to medications
  • New difficulties in decision making
  • Poor hygiene
  • Poor nutrition
  • Sleep problems
  • Family problems
  • Financial problems
  • Legal difficulties
  • Social isolation
  • Increased alcohol tolerance

14
Special Populations
  • Barriers to effective identification exist for
  • Women
  • Certain minority group members/lack of culturally
    competent tools and interventions
  • Individuals with physical disabilities,
    comorbidities
  • Homebound

15
Co-morbid Conditions
  • Co-morbidity is a serious, common concern among
    older adults using alcohol
  • Impaired Activities of Daily Living (ADLs)
  • Psychiatric symptoms, mental disorders
  • Alzheimers Disease
  • Sleep disorders

16
Screening
  • Rationale of screening for alcohol use problems
    among older adults
  • Incidence is high enough to justify costs
  • Adverse quality/quantity of life effects are
    significant
  • Effective treatment exists
  • Valid cost-effective screening exists
  • Goal of screening for alcohol use problems in
    older adults is to
  • Identify at-risk drinkers, problem drinkers, and
    persons with alcoholism
  • Determine need for further diagnostic assessment

17
Screening Instruments
  • Short Michigan Alcohol Screening Test-Geriatric
    Version (SMAST-G)
  • Health Screening Survey, includes other health
    behaviors (nutrition, exercise, smoking,
    depressed feelings) includes quantity
    frequency questions
  • CAGE (Cut down, Annoyed by others, Feel Guilty,
    need Eye opener)

18
SMAST-G
  • Two or more yes responses is indicative of
    alcohol problem (0-10 possible)
  • Yes or no answers to
  • 1. When talking with others, do you ever
    underestimate how much you actually drink?
  • 2. After a few drinks, have you sometimes not
    eaten or been able to skip a meal because you
    dont feel hungry?

19
SMAST-G (cont.)
  • 3. Does having a few drinks help decrease your
    shakiness or tremors?
  • 4. Does alcohol sometimes make it hard for you
    to remember parts of the day or night?
  • 5. Do you usually take a drink to relax or calm
    your nerves?
  • 6. Do you drink to take your mind off your
    problems?
  • 7. Have you ever increased your drinking after
    experiencing a loss in your life?

20
SMAST-G (cont.)
  • 8. Has a doctor or nurse ever said they were
    worried or concerned about your drinking?
  • 9. Have you ever made rules to manage your
    drinking?
  • 10. When you feel lonely, does having a drink
    help?

21
Quantity/Frequency Screen
  • 8 or more drinks/week or 2 or more occasions of
    binge drinking in last month are indicative of
    alcohol use problems
  • 1. In the last three months, on average, how many
    days a week have you been drinking alcohol?
  • 2. On a day when you have had alcohol to drink,
    how many drinks have you had?
  • 3. In the last three months, how many times have
    you had 3 or more drinks on an occasion?

22
Screening Results
23
Intervention with Older Adults
  • Preventive education for abstinent, low-risk
    drinkers
  • Brief, preventive intervention with at-risk and
    problem drinkers
  • Alcoholism treatment for abusing/dependent
    drinkers

24
Brief Intervention
  • Defined as time limited (5 minutes to 5 brief
    sessions)
  • Targeted (at a specific behavior)
  • Goal directed
  • Reducing alcohol consumption
  • Facilitating treatment entry
  • Relies on screening techniques
  • Empirical support with younger drinkers, across
    settings

25
Brief Intervention (cont.)
  • Empirical study with older adults is limited
  • Project GOAL (Guiding Older Adult Lifestyles)
    physician advice for at-risk older drinkers led
    to reduced consumption at 12 months by 35-40
    (N156, U of Wisconsin)
  • Health Profile Project Preliminary findings,
    elder-specific motivational enhancement session
    reduced at-risk drinking at 12 months (N454, U
    of Michigan)

26
Brief Protocols with Older Adults
  • Brief intervention/motivational enhancement are
    effective approaches
  • Accepted well by older adults
  • Can be conducted at home, in clinic
  • Reduces alcohol use
  • Reduces alcohol-related harm
  • Reduces health care utilization

27
Brief Protocols (cont.)
  • Ten components
  • Identify future goals (health, activities, etc.)
  • Customized feedback
  • Defining drinking patterns
  • Pros/cons of drinking (motivation to change)
  • Consequences of heavier drinking
  • Reasons to cut down or quit drinking

28
Brief Protocols (cont.)
  • Setting sensible limits, devising strategies
  • Develop a drinking agreement
  • Anticipate and plan for risky situations
  • Summary of the brief session
  • 10

29
Other Treatment Approaches
  • Cognitive-behavioral
  • Group-based counseling
  • Individual counseling
  • Medical/psychiatric approaches
  • Marital and family involvement/family therapy
  • Case management/ community-linked services and
    outreach
  • Formalized substance abuse treatment

30
Conclusions
  • Screening for alcohol use problems among older
    adults is effective
  • Brief interventions are effective
  • Additional interventions complete the spectrum of
    effective approaches
  • Approach depends on individual client background,
    assessment of needs, goals, resources,
    preferences
  • Intervention is available

31
Conclusions (cont.)
  • Older adults benefit from screening, assessment,
    referrals, prevention, and intervention delivered
    from social workers sensitive to elder issues
  • Non-judgmental approach
  • Motivational
  • Supportive approach

32
Recommendations
  • Social workers in any setting with older adult
    clients should be prepared for
  • Recognition and assessment of alcohol use
    problems (quantity and frequency limits)
  • Initial management and referral (for further
    assessment/treatment when indicated)
  • Structured brief interventions when appropriate
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