By Mary Alice Casey

Joseph is a good man. A retired rail worker, he spends his days caring for his ailing wife, who is debilitated by heart problems and Alzheimer’s disease. At 72, he resists leaving the southeastern Ohio community he has called home for a lifetime, turning down his children’s invitations to move closer to them. He has given up his small social life and most of his hobbies, absorbing himself in his wife’s care and keeping up the home they have shared for most of their married life.

Joseph allowed himself one outlet from the stress of care-giving, the guilt of resenting his many responsibilities and the grief of watching his soul mate wither away. He found his solace in a bo ttle.

On medication himself for high blood pressure, Joseph was driving to the drug store one afternoon to pick up his wife’s prescriptions when a police officer noticed his slow-moving car weaving across the center line. A blood-alcohol test confirmed the officer’s suspicions and Joseph was arrested for driving under the influence of alcohol.

“The stress of not working, of caring for his beloved wife — who was clearly exhausting to care for — had him seeking relief in very regular, daily d rinking,” says Lesley Pickering of Health Recovery Services in Athens.

When Pickering and others intervened at the court’s order, they quickly discovered the source of Joseph’s problems and helped him find other ways of coping. Treatment specialists timed their work around Joseph’s obligations to his wife. Counselors focused educational efforts at preventing a recurrence. His children, who like Joseph never suspected he had an alcohol problem, came to his aid. Fellow seniors he met through Alcoholics A nonymous offered support and companionship.

“He felt such relief to experience a sense of community again,” says Pickering, MHSA ’87, an acoholism counselor for 30 years. “There were people all around who were willing to help once they knew what the problem was.”

Yet too often when the elderly are involved, “the problem” is viewed as something other than alcohol abuse, says Dr. Steven Clay, an Ohio University assistant professor of geriatric medicine who also is certified in substan ce abuse.

Oh, he’s old.
It’s Alzheimer’s.
Maybe he’s had a little stroke.
He’s just confused.

Such statements frequently are used to pass off alcohol abuse among the elderly. Yet with modest estimates putting the number of senior citizens who abuse alcohol at 3 percent to 5 percent of the population, and the elderly segment of the population projected to grow from 12 percent today to 20 percent in a little more than three decades, it’s time to take the situation seriously, Clay says. If the current trend continues, as many as 3.5 million elderly Americans could be abusing alcohol by 2030.

Where to get help Older problem drinkers have a good chance of recovery because of their commitment to stick with a treatment program once they seek help, according to the National Institute on Aging. If you or someone you love has a possible drinking problem, here are some places to turn for help: Your family doctor, clergy member or local health department. Health Recovery Services, 100 Hospital Drive, Athens, Ohio, 45750. (740) 592-6720. Alcoholics Anonymous, 475 Riverside Drive, 11th Floor, New York, N.Y., 10115. (212) 870-3400. American Association of Retired Persons, Social Outreach and Support, 601 E St. N.W., Washington, D.C., 20049. National Institute on Aging Information Center, P.O. Box 8057, Gaithersburg, Md., 20898-8057. (800) 222-2225. National Institute on Alcohol Abuse and Alcoholism, 6000 Executive Blvd., Bethesda, Md., 20892-7003. (301) 443-3860. National Council on Alcoholism and Drug Dependence Inc., 12 W. 21 St., Eighth Floor, New York, N.Y., 10010. (800) 622-2255.

“The elderly population is the fastest-growing population in our society,” Clay says. “And they’re on multiple medications. You add alcohol to that and there will be greater utilization of doctors, more drug interactions, more p roblems with falls and fractures, and more difficulties with the elderly being able to care for themselves.”

That’s why Clay is advocating that doctors, when treating the elderly, abandon the tool they most often use to screen for alcohol problems in favor of one that better applies to older patients. Three of the four questions on the popular CAGE questionnaire focus on the consequences of alcohol use: Have you ever felt you should cut down on your drinking? Have people annoyed you by criticizi ng your drinking? Have you ever felt bad or guilty about your drinking? The fourth question asks whether the person being interviewed has ever had a drink first thing in the morning to steady nerves or get rid of a hangover.

“What if you’re retired, living alone because your husband or wife is gone?” Clay asks. “Three of the four CAGE questions don’t really fit.”

In a study funded by the Ohio University College of Osteopathic Medicine, Clay sought to validate another type of test, the Alc ohol Use Disorders Identification Test (AUDIT), as an effective screening method for use among the elderly. Unlike CAGE, it focuses on the quantity and frequency of alcohol use. He surveyed 33 male and 60 female patients of four family medical practices in southeastern Ohio. Clay questioned the patients — all age 65 or older — using both methods. He also compared the participants’ alcohol use patterns with the National Institute of Alcohol Abuse and Alcoholism recommendation that elderly men consume no mo re than one drink daily and no more than two on special occasions and that women consume less than that.

The outcome of Clay’s study was clear: Of the 93 participants, five screened positive for potential alcohol problems under the CAGE questionnaire while seven and 13 patients scored eight and five points, respectively, on an AUDIT screening. Clay advocates further investigation if a patient scores five points on an AUDIT questionnaire. Nine of the ninety-three survey participants drank more than th e limit of one drink per day recommended by the National Institute of Alcohol Abuse and Alcoholism.

Clay says the 10-question AUDIT screening method, developed by the World Health Organization in 1987, is a better gauge of elderly patients’ alcohol use because it centers on actual consumption habits rather than perceptions about use. And while some patients who do not abuse alcohol may test positive using this screening instrument, Clay would rather turn up some false positives than let patients’ alc ohol problems go undetected.

“It’s a screening method. And if you come up with somebody who screens positive, you’ve really got to do more work to figure out what’s going on,” he says.

Clay believes physicians favor the CAGE test because it’s short and its questions can be worked into a routine checkup. Yet the consequences of missed diagnoses among the elderly are dire because of older patients’ vulnerability to alcohol, Clay says. On average, the elderly use an estimated 4.5 medications a t any given time, raising the risk of dangerous alcohol-drug interactions. They also have a lower tolerance for alcohol and a reduced ability to metabolize it as a result of the normal physiological changes that come with aging.

“We can’t continue to ignore it,” Clay says of the issue of alcohol abuse among the elderly. “It’s a huge, huge problem.”

Mary Alice Casey is editor of Ohio University Today.