Elderly alcoholics a hidden problem — doctors

Press, 3 July 1985, Page 30

Elderly alcoholics a hidden problem — doctors

By

GLENN COLLINS

of the ‘New York Times’ (through NZPA) NEW YORK New research findings suggest that alcoholism among the elderly is a more serious problem than previously believed. A number of experts believe that alcoholism has long been confused with the symptoms of other diseases among the aged. They see alcoholism as a hidden contributor to some of the most prevalent ailments of the elderly, including mental problems, broken bones from falls, and other disabilities such as incontinence. Researchers have found that not only does alcoholism have debilitating effects on the health of the elderly, but that it can mask the symptoms of other serious illnesses also. The findings, about both the extent and the nature of problem drinking among the old, have led a variety of United States Federal agencies to increase their efforts to study the problem. The number of elderly problem drinkers in the United States is expected to rise as the nation’s aged population increases, even though the rate of alcoholism among the elderly is lower than in the general population. “Even if the over-all percentage of alcoholism in the elderly population is low, it is a huge national problem,” said Dr Michael Freedman, director of the division of geriatric medicine at New York University Medical Centre. “Until relatively recently, many doctors had certain preconceptions about old people, and this led to misdiagnoses,” he said. “For example, in some patients, symptoms that were thought to be those of senility were actually being

caused by alcoholism. I think we are still underdiagnosing alcoholism among the elderly.” Studies of the scope, causes and effects of alcohol abuse by the aged are being made by the National Institute of Mental Health, the National Institute on Alcohol Abuse and Alcoholism, the National Institute on Aging, and the Veterans’ Administration. “Those who are studying alcohol and the elderly are on the cutting edge of a relatively new field of research,” said Dr Ernestine Vanderveen, chief of the psychosocial research branch at the alcoholism institute. "We’re trying hard to stimulate research interest in this area,” she said. Financing for such research was increasing. She could not place a specific cost on studies of alcoholism and ageing, because such research was often part of broader studies involving alcoholism, the elderly, and mental illness. More than a million of the 28 million Americans over the age of 65 are believed to be problem drinkers, according to the National Council on Alcoholism, a nonprofit-mak-ing educational organisation. A 1982 study by Dr Jacob Brody, of the National Institute on Aging, suggested that from 10 to 15 per cent of elderly patients seeking medical help had a drinking problem related to their ailment. The study suggests that alcohol abuse or dependence is a problem for 1.4 to 3.8 per cent of men aged over 65 in the research sample, and from 0.1 to 0.7 per cent of the women in that age group. Additional findings from interviews in Los Angeles have not been analysed. More than 20,000

people will be interviewed. The institute’s interviewers defined alcoholism according- to the criteria of the Diagnostic and Statistical Manual of Mental Disorders of the American Psychiatric Association. Subjects were diagnosed as abusing alcohol according to their scores in a variety of categories assessing their patterns of alcohol use, including whether they had a daily need to drink, whether they were unable to stop drinking, whether they went on drinking binges or suffered from black-outs, or whether they had missed work or been in accidents because of drinking. “Until recently we have had very little in the way of accurate information about this population,” said Dr Nathan Rosenberg, the health scientist administrator at the alcoholism institute. Research has drawn a distinction between two groups: those who begin drinking early in life, and those who begin late in life, often in response to loneliness or the deaths of loved ones. Of the latter group he said, “It is possible that the late-onset drinkers may be experiencing a recurrence of drinking problems in their 20s or 30s. We just don’t know as yet.”

On the other hand many of the elderly who were not now problem drinkers might have been alcoholics in the past, said Dr Dan Blazer, a professor of psychiatry at the Duke University Medical School. As director of the Affective Disorders Programme there, he has conducted research on problem drinking and the old. Dr Blazer said that there was evidence that drinking among the elderly declined, compared with the drinking of younger people. “We have younger groups of people who are moving into later life who have a history of drinking more heavily. So we may have increased prevalence in future years.

Dr Blazer added that the number of elderly alcoholics would rise as the numbers of the elderly increased. Often the elderly had multiple health problems with complications and these problems could be masked and become very serious.”

Among some elderly people, memory loss, paralysis, peripheral nerve problems, and liver and kidney ailments may actually be symptoms related to alcohol abuse. Since the elderly, just as those in other age groups, had difficulty telling others that their drinking was a problem, both the

patients and their doctors may ascribe the symptoms of alcohol abuse to other ailments. k “Alcohol can interfere with many of the medications regularly prescribed to the elderly,” Dr Freedman said. "Alcohol is especially « dangerous in combination r with central-nervous-system depressants — barbiturates, tranquilisers, and painkill- > ers. Alcohol can even cause ? problems in combination with something as simple as aspirin, due to the effect on •- the stomach.” Dr Rosenberg said that the prominent areas off-, research into alcohol and the aged included the effect ~1 ( of various levels of long- v term drinking on memory £ los?, the rate at which •- alcohol was metabolised byff the elderly, and the interac- i c tion of prescription drugs and alcohol. i» Also, more research was ; n needed to understand how elderly problem drinkers * could be best treated, said Dr Freedman. The isolation, poverty, and physical disaoility of many elderly alcoholics posed special difficulties for those who ran rehabilitation programmes. ’ “This is a large national problem, and little treatment is available,” Dr Freedman said.