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Monday, November 11, 2002 - Page updated at 12:00 AM

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Hidden epidemic: Substance abuse's toll on seniors

Seattle Times staff reporter

Test questions


Health-care providers often use this geriatric version of the Michigan Alcoholism Screening Test to determine if an older adult has a serious drinking problem.

The test was developed by Frederic Blow and others at the University of Michigan. Blow is a national expert on older adults and substance abuse.

This is the short version of the test. A person who answers "yes" to two or more questions is likely to have a problem and should seek a more formal assessment.

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 didn't feel hungry?

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?

8. Has a doctor or nurse ever said he or she was 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?

Ed King started drinking heavily — "a couple of those big jugs ... hard stuff ... every night" — after being fired for the first time in his life, and from the only job he'd ever cared about as director of youth services for Clallam County. At 55, he was just months from eligibility to retire.

He blames the firing on politics and fights over funding with the county commission. Then, his marriage collapsed. After that, he quit playing golf and attending family functions. To feel good enough to get up each morning, he sat on the edge of the bed and downed a vodka and Coke.

"I just pulled out all the stops. I was drinking all day long. I was really miserable."

For more than a year now, King, of Seattle, has been sober.

But his struggle with drinking makes him part of what has been called a "hidden health epidemic." Alcohol abuse and prescription-drug misuse are challenging millions of older Americans and likely to get worse as baby boomers age. The problem's current toll — social, economic and medical — and the implications for the future are prompting a push for education, screening and early treatment.

"Those baby boomers are going to be drinking lots and probably using other substances," says Frederic Blow of the University of Michigan, one of the nation's foremost experts on older adults and substance abuse.

Blow spoke at a Seattle-area conference last week on prevention of and treatment for substance abuse among older adults.

Experts say baby boomers have always abused alcohol and drugs in greater percentages than their parents did at the same age. That leads to conjecture that they'll be willing to use the same substances at the same higher rates as they grow old, Blow says.

As a generation, they're also more likely to take a pill to solve problems, thanks to medical breakthroughs and availability, whereas their parents were more likely to tough it out.

"All of this leads to more of a problem with alcohol, illegal substances and prescription psychoactives such as sedatives, hypnotics, tranquilizers and pain killers," Blow says.

Addiction goes undetected

Abuse and misuse of alcohol and prescription drugs is one of the most significant health problems facing older adults, affecting an estimated 17 percent or roughly 7.7 million people age 60 and over. A federal survey estimated more than a half-million people age 55 or older used illegal drugs in the past month; more than 5 million were binge alcohol users, including 1 million who were heavy drinkers.

Their rates of addiction are lower than those in younger groups. But their addiction also goes more widely undetected and undertreated. The reasons are many — ageism, shame and, often, ignorance about the relatively new, lower recommended drinking levels for seniors.

"We believe a number of people are drinking in a risky manner or taking medication without knowing they're jeopardizing their health and the effectiveness of their medication," says Alixe McNeill, a vice president with the National Council on Aging.

Senior substance abuse places greater demands on family caregivers, leads to poorer health and quality of life and increases use of costly health care.

Research using Medicare claims suggests substance abuse plays a role in almost 70 percent of older adult hospitalizations. Between 20 and 50 percent of nursing-home residents are admitted with alcohol-related problems. Some continue to drink after moving in with the help of family, nursing-home staff members and delivery drivers. But often no one is paying attention to who's at risk, says Blow.

Educative tool kit

In response to the lack of awareness, new prevention and education efforts are emerging.

By year's end, the federal government is expected to release a "tool kit" nationwide to provide basic screening techniques and education on older adults and substance abuse to thousands of social-services agencies and medical providers.

The kit was developed by the Substance Abuse and Mental Health Services Administration (SAMHSA,) an arm of the federal Health and Human Services Administration.

In 2003, the agency also expects to award several million dollars in grants nationwide to pay for education and treatment for older adults and support services, such as transportation and meals.

New research is looking at self-screening and education on the Internet, families' role in identifying older drinkers and getting them into treatment, and whether treatment should be elder-specific or mixed age. A few states have major initiatives to improve mental health and decrease substance abuse by older adults.

But there's still a long way to go. Too little treatment and money is available, say public-health officials.

Scanty funding

Over the years, for example, Washington state has supported some training for community health workers, particularly in King County, on how to identify older adults with substance-abuse problems.

But there's no commitment for statewide education or beefed-up treatment for older adult substance abusers. Federal and state laws require that money for state alcohol- and drug-treatment programs must be spent first on pregnant women, injection drug users, children and parents with small children. There is no funding earmarked for elderly populations.

"As we move into the future and the population begins to age, you will see our system shift slowly," says Ken Stark, director of the division of alcohol and substance abuse in the Department of Social and Health Services.

The belief used to be that if a person wasn't an alcoholic by age 45, he or never would become one. The person either died or matured out of the addiction, says Carol Colleran, director of older-adult services at Hazelden, a well-known addiction-treatment program headquartered in Minnesota.

"The fallout was very little research was ever done on older adults because they didn't believe it ever merited the attention," Colleran says.

Risks rise with age

For a significant minority of older adults, serious drinking problems don't start until later life, based on several studies of people in treatment and in the community. Cocktail hour is a common event in retirement communities.

The trigger also can be a loss of status or boredom and loneliness in retirement. A spouse may die. Physical disability sets in. Depression and substance abuse may go hand in hand.

Or the biology of an aging body simply takes over.

Current thinking holds that a broader spectrum of older adults than once thought are vulnerable. In the last few years, research has shown even moderate alcohol use can be risky for older adults because they absorb alcohol more quickly and metabolize it more slowly.

The recommended alcohol-consumption levels for adults age 60 and over are half of what's OK for younger people: No more than one drink a day for a man. Women are supposed to drink slightly less.

"I have a lot of friends right now who drink excessively," says a retired college administrator, who has been sober about four months. "It would never occur to them that they are alcoholics. People don't know enough to understand they have a problem."

The administrator began drinking seriously at age 63, when she had to start caring for her bedridden husband.

At night, she couldn't wait to administer his last dose of medication so she could go to bed, read and drink wine.

Today, at age 70 she attends an Alcoholics Anonymous meeting every morning, then goes to an aerobics class or on a brisk walk. She's making friends with people who aren't heavy drinkers.

Misuse of prescription drugs is another danger. Older people are prescribed medication much more often than younger people and are less likely to accurately follow dosage instructions. Because of decreased liver and kidney function they are at greater risk for unhealthy side effects, such as falls or drug reactions that could lead to

Many family members, medical providers and even seniors assume "you can't teach an old dog new tricks" and that it's too late for treatment in later life.

But the good news is that specialized screening tools exist to identify older adults with addiction problems, such as the geriatric version of the Michigan Alcoholism Screening Test. It asks questions such as: "Have you ever increased your drinking after experiencing a loss in your life?"

And recent studies show that even a brief intervention in a doctor's office can be effective in getting older people who aren't heavy drinkers to cut back and enjoy a better quality of life in their last years.

Filling the void

Ed King kept up a heavy pace of drinking for a year. Then one day he couldn't quit vomiting. His liver shut down. Hooked to an IV in the hospital, the retiree heard he probably had two weeks to live. He was 66 years old.

But then he got lucky. His vital signs improved.

A small voice echoed in his head: "What if you live?"

King was upset. Dying wouldn't be so bad, but living like this forever?

"So what do you want," the voice asked.

It boiled down to friends, respect and peace. Not vodka and Coke.

With a doctor's encouragement, King entered an alcohol-treatment program geared to older adults. Most had been successful in life with careers and family.

"A lot of them didn't start drinking until they retired. They had so much time on their hands they didn't know what to do with it and so they started drinking," King says.

And, like him, many had failed to establish relationships that would carry them through later life.

King set out to fill that void. Today, he volunteers with the Veterans Administration and Children's Hospital; he mentors other older adults about staying healthy, and vigorously practices his golf swing at the driving range for exercise. He's decided to lose weight.

And when he wakes up in the morning he prays — prays that he will be a blessing to someone else that day.

"Then I go looking to find whoever that it is," he says with a laugh. "Or maybe they're looking for me."

Marsha King: 206-464-2232 or mking@seattletimes.com.

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