The National Council of Alcoholism and Drug Dependence (NCADD) recently reported that widowers over the age of 75 have the highest rate of alcoholism in the U.S. While this number may seem shocking, in reality, it is part of growing trend of substance use disorder among older adults. Today, there are 2.5 million American older adults struggling with substance use disorder, some of whom have recently become addicted and others who have been struggling their entire lives. This is a tremendous problem, one that has grown significantly in recent years due to the aging baby boomer demographic and an overprescribing of prescription medication. In fact, nearly half of nursing home residents have a substance use disorder, and seniors are admitted to hospitals as often for alcohol-related problems as for heart attacks.
An epidemic hidden in plain sight
Alcoholism and substance abuse among older adults is not a new problem, but it has largely been underreported or misdiagnosed. As the NCADD points out, there are numerous life changes that may drive recently widowed older adults toward self-medication: Retirement, downsizing, failing physical health, physical pain, and more. Loss and grief are particularly significant for this population.
At age 75 and above, widows and widowers are retired, so the loss of a spouse results in a sudden loss of social contact and companionship simultaneously, making it overwhelmingly stressful. Older males in particular are deeply affected by the loss of a spouse because the loss compounds a loss of identity brought on by retirement. A study by the NCBI examining alcohol consumption in recently widowed older men showed those at the age of 75 were a high-risk group for hazardous alcohol consumption, as well as a target group for preventative intervention.
Seniors also take most of the medications prescribed in America, often taking many medications from different doctors at one time. This use puts them at significant risk for drug interactions, interaction between alcohol and medications, dependence and addiction. In fact, nearly 17 million prescriptions for tranquilizers are prescribed for older adults each year – and they are the most frequent users of over-the-counter medications. All of this is helping us learn why older adults are so vulnerable to addiction and recognize how the issue has been overlooked for so long.
- Loss of purpose. When I stress the dangers of consuming addictive substances to older patients, I sometimes hear the risk doesn’t matter to them -- they feel they only have a little time left in life and prefer to spend it however they wish. This indicates loss of purpose. It’s never too late to lead a fulfilling life, and recovery can help them achieve that.. Treatment can be just as fulfilling for a 65-year-old, or a 90-year-old, as it is for a 35-year-old.
- The Silent Generation lives up to its name. Losing a spouse or partner can have a devastating impact on an older adult. Not only have they likely been in that relationship for a significant portion of their lives, they are typically more prone to isolation. This is compounded by the loss of mobility, independence, and activity, all of which have a profound psychological influence. Known as the Silent Generation, older adults grew up in a culture where mental health issues were not addressed and there was a tendency to minimize family trauma. At the same time, self-medicating with alcohol and other substances was frequently the norm. Many older adults even have memories of learning to “fix” their father’s favorite drink as he returned home from work. It can be more challenging to share their personal pain with others because it’s counter to what they learned.
- Aging unsafely. The heart, liver, kidney, central nervous system, and brain all react differently to medications and alcohol in advanced age, and mixing the two may bring on adverse reactions. Older adults also don’t metabolize substances as they did at younger ages, and the body takes longer to cleanse itself of alcohol and medication. Withdrawal is also significantly more dangerous for an older adult. In this population, their substance use may have started younger, and therefore, the complications – such as cardiovascular events and organ malfunctions – appear to be more severe than the general population.
- Addiction isn’t the first thing we think of when we see impairment in older adults When monitoring an older adult’s health, healthcare professionals and loved ones may be more attuned to issues such as dementia, Alzheimer’s disease, frailty, loss of balance, and reduced hearing and sight. Further confusing matters, the symptoms of substance use disorder may mirror those of these common diagnoses, as well as the signs of the aging process in general.
Making the Most of Life in Recovery
Despite the challenges older adults face, they’re often very successful in recovery. They are more likely to follow clinical recommendations, have great respect for medical professionals, and consider family their greatest motivator for sobriety.
For instance, if an older adult is in denial about the havoc substance abuse is wreaking on their bodies, when a medical professional presents them with the scientific facts and evidence about these effects, it often is the strategy that breaks through their denial. Raised to be respectful of doctors, they tend to trust their words. In another case, as the NCADD suggests, older adults may simply be unaware of the new effect the medications they’ve always taken and the amount they have always consumed are having on their body as it changes. A doctor can give them the resources and instructions they need to take charge of their health.
Older adult treatment programs should be very family-intensive. In many cases, this is because access to children and grandchildren are the one thing they have “left to lose.” The promise of seeing grandchildren again when they are well becomes an incredible incentive. While the patient is complex, the outlook in older adult addiction recovery is very positive.
It is time for us to recognize this hidden epidemic among older adults. We must be acutely aware of the effect the loss of spouse and has on the remaining partner and not allow their distress to be lost among the family’s collective grief. The first three years as a widow or widower are the most dangerous times in this type of bereavement, so families should monitor closely.
We must improve the quality of life for our older generations. The more caregivers, healthcare professionals, and family understand about the warning signs the more likely that older adults will get the correct diagnosis and be able to truly appreciate their golden years.
By Carol Waldman
By Ming Wang, MD, FASAM