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The Greatest Fears in Grief
Caregiving

Addressing Drug or Alcohol Abuse as a Live-In Caregiver

by Kimberly Johnson
written by Kimberly Johnson

How to Talk About Drug or Alcohol Abuse as a Live-in Caregiver and What to Look Out For

When you’re a live-in caregiver, your No. 1 priority should be the health, safety and well-being of the person you’re caring for. Given the rising tide of prescription drug and alcohol abuse among today’s seniors, that entails knowing the signs of drug and alcohol abuse—and being able to talk about a potential problem with drugs or alcohol when you have suspicions. Addressing Drug or Alcohol Abuse as a Live-In Caregiver

Substance Abuse and the Elderly

Substance abuse by elderly Americans—particularly of alcohol and prescription drugs—is “an invisible epidemic,” a report by the Substance Abuse and Mental Health Services Administration warned in 1998.
By a recent estimate, more than half of older adults (ages 65 and older) drink alcohol, and of these seniors, roughly one in five drinks to excess at unsafe levels, according to a CBS News report in 2015.

Prescription drug abuse, too, is cause for concern, as evidenced by the fact that a vast majority (87 percent) of older Americans take at least one prescription drug on a regular basis, according to a 2005 report by the American Association of Retired Persons (AARP). Among elderly people who seek medical attention, the rate of prescription drug abuse is reportedly between 13 and 15 percent. (The actual rate of drug abuse is likely much higher, given that many instances of abuse go unreported.)

Signs of Alcoholism and Drug Abuse – What to Look for

The signs of alcoholism and/or drug abuse in older Americans can be harder to miss—hence the term “invisible epidemic.” For example, a reliable sign of a substance use disorder (SUD) is having problems at work, but many older Americans are retired and no longer working. They may therefore not manifest this more obvious warning sign of a drug or alcohol problem. Sometimes, too, the symptoms of a SUD can masquerade as merely the natural symptoms of aging.

Live-in caregivers, by virtue of dwelling in close proximity to their elderly clients, are uniquely positioned to catch the signs of a potential SUD, however. In this sense, they are first responders on the frontlines of catching a substance abuse problem before it’s too late. Below are signs to look for if drugs or alcohol may be a source of concern: Addressing Drug or Alcohol Abuse as a Live-In Caregiver

  • Drinking alone and often
  • Ritualized drinking (for example, needing a drink at a certain hour of the day and becoming frustrated, irritable or belligerent when that’s not possible)
  • Drinking in spite of label warnings on prescription drugs or the misuse of prescription drugs
  • Slurred speech, the smell of liquor on one’s breath and/or signs of intoxication
  • Changes in mood (seeming down, anxious or depressed or more prone to sudden outbursts)
  • Memory problems
  • Unexplained burns, bruises, falls or other injuries
  • Other worsening health problems—or, chronic health complaints that seem to have no physical cause
  • A loss of interest in hobbies that once brought pleasure
  • A history of alcohol abuse or a recent life-changing event such as the loss of a spouse or retirement (coupled with one or more of the above signs)

Tips for Talking About Drug or Alcohol Abuse

If you suspect drug or alcohol abuse is at play based on the above signs, talking about your concerns may be the next step (depending on the circumstances). When you broach your concerns regarding drug or alcohol abuse, the following guidelines may help:

  • Talk with the person when they are not drinking or under the influence. If the person is intoxicated or under the influence of alcohol or another drug, he or she will be less likely to hear you or more prone to defensiveness.
  • Emphasize your love and concern. Someone with an addiction problem is more likely to listen to your concerns when on the receiving end of a loving attempt to connect. This is not the time for barking orders or flushing pills or liquor down the toilet or sink dispenser. Instead, stay positive, by noting the qualities you admire in the person, the memories you’re grateful for, and the positive core values he or she has modeled for you (such as the love of family or the importance of faith). These core values can also be a way to reinforce the positive motivation(s) someone with a potential SUD might have for getting treatment. For example, if you know family is important to him or her, spending quality time with grandchildren may be a good incentive to enter drug or alcohol treatment.
  • Be gentle but direct about your concerns. In a great number of instances, just because a client is elderly does not mean he or she is not able to understand you, or needs to be babied or sheltered from the truth. Matter-of-factly and as non-judgmentally and non-confrontationally as possible, mention the behaviors you’re noticing that are causing you concern and why.
  • Avoid the terms “drug addict” and “alcoholic.” Because these terms can be stigmatizing, they can perpetuate people’s sense of shame and/or denial, thereby pushing them further away from receiving help. Addressing Drug or Alcohol Abuse as a Live-In Caregiver

 

By Linda Williams
Linda Williams is the Executive Director of Beach House Center for Recovery. She is also a seasoned clinician with specialization in addiction and trauma.
For additional information please visit The National Council on Seniors Drug & Alcohol Rehab: https://rehabnet.com/

Addressing Drug or Alcohol Abuse as a Live-In Caregiver

Addressing Drug or Alcohol Abuse as a Live-In Caregiver Addressing Drug or Alcohol Abuse as a Live-In Caregiver Addressing Drug or Alcohol Abuse as a Live-In Caregiver Addressing Drug or Alcohol Abuse as a Live-In Caregiver

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Link Between Immobility and Substance Abuse
Conditions & Treatments

Link Between Immobility and Substance Abuse

by Guest Blogger
written by Guest Blogger

If growing older weren’t hard enough already, aging can often entail a loss of physical, psychological and/or environmental mobility, which in turn raises the risks of a drinking problem. Consider, for example, that nearly 50 percent of nursing home residents have alcohol-related issues, according to statistics from the National Council on Alcoholism and Drug Dependence. Link Between Immobility and Substance Abuse
This link between immobility and substance abuse among the elderly can be easy to miss— both for those who are most vulnerable (seniors) and for their loved ones. Exactly how are immobility and alcohol abuse connected in older adults, and how do you know if you or a loved one is affected? Below are answers to these questions, along with some tips for coping with aging-related immobility in healthy ways.

How Immobility and Substance Abuse Are Connected

Immobility is very common in old age because of physical, psychological and environmental factors that, in addition to restricting older adults’ freedom to get around, make them more susceptible to alcohol abuse and addiction:

  • Physical Causes of Immobility – Arthritis, osteoporosis, hip fracture, stroke and Parkinson’s disease are the biggest causes of immobility in old age, according to researchers. But heart disease, diabetes, and other physical conditions that are more common in old age—chronic pain, for example—can contribute to the same phenomenon, thereby relegating a previously active and independent adult to a homebound existence.
  • Psychological Causes of Immobility – Impaired mobility can also be the consequence of cognitive and emotional issues related to aging. These can include dementia; anxiety and depression; a fear of falling or getting hurt; low motivation; and grief after losing a spouse.
  • Environmental Causes of Immobility –The loss of a license is a major contributor to immobility in old age, as is the lack of transportation by able-bodied friends or family members when driving is no longer permitted. Similarly, a homebound senior who does not have adequate care or the help of assistive devices that make it easier for them to get around—handrails on stairs, bars in the shower, a walker or wheelchair, etc.—can end up bedridden.

These many causes of immobility in old age naturally can be accompanied by difficult emotions, such as feelings of anger and sadness over a loss of independence and embarrassment about having to be dependent on others to get around. And these often negative and uncomfortable emotions may trigger drug or alcohol abuse, research has suggested.

Alcohol Abuse in Older Adults: Warning Signs to Watch for

If a senior’s drinking typically occurs as an effort to dull or soothe difficult or painful emotions related to a loss of mobility, they may therefore be suffering from alcohol abuse. Other warning signs to watch for in discerning a potential alcohol problem include:

  • A pattern of solitary drinking
  • A loss of interest in former hobbies
  • Drinking despite warning labels on prescription drugs
  • Chronic health complaints
  • Memory loss and mental confusion
  • A decline in personal hygiene on account of drinking

Coping With Aging-Related Immobility in Healthy Ways

We have now established that coping with aging-related immobility can be emotionally hard, and that it is not uncommon for a drinking problem to develop in the absence of healthy coping tools. One of the best ways to protect one’s health in the golden years, then, is to surround oneself with a healthy emotional support network. Research at UC Berkeley has confirmed this observation. Specifically, seniors who live in neighborhoods with high levels of “social capital” where “there is more trust and more helpful neighbors,” reportedly enjoy greater mobility—and, by implication, lower rates of alcohol abuse.
What’s the takeaway for good health? That in the older years, relationships of mutual trust and support are arguably more important than ever, and that surrounding oneself with a robust support network is key. In other words, the more you or a loved one struggling with immobility can make use of opportunities to socialize, the healthier you’ll be.
About the Author
Anna Ciulla is the Vice President of Clinical and Medical Services at Beach House Center for Recovery, where she is responsible for designing, implementing and supervising the delivery of the latest evidence-based therapies for treating substance use disorders. Anna has a passion for helping clients with substance use and co-occurring disorders achieve successful long-term recovery.

Link Between Immobility and Substance Abuse

Link Between Immobility and Substance Abuse Link Between Immobility and Substance Abuse Link Between Immobility and Substance Abuse Link Between Immobility and Substance Abuse Link Between Immobility and Substance Abuse Link Between Immobility and Substance Abuse Link Between Immobility and Substance Abuse Link Between Immobility and Substance Abuse Link Between Immobility and Substance Abuse
 

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When Roles Reverse: Talking to Parents About Alcohol
Healthy Living

When Roles Reverse: Talking to Parents About Alcohol

by Guest Blogger
written by Guest Blogger

In every parent-child relationship, there eventually comes a time when roles reverse. It’s a natural and inevitable extension of the aging process. The mom or dad who once changed your diapers, drove you to soccer practice, and applied Band-aids to skinned knees will gradually lose their mobility and independence, requiring greater help and supervision with their own health and safety needs. For the child who in turn is tasked with caring for an aging parent, navigating this new juncture can be difficult because it means taking a more directive role in relation to a grown-up who, in addition to having parented you, is used to having their own independence and making their own lifestyle decisions. When Roles Reverse: Talking to Parents About Alcohol
Take, for example, the issue of alcohol consumption in old age. It’s a biological fact that alcohol tolerance decreases as you age, so that moderate drinking that caused no health problems earlier in life may pose serious dangers later in life, purely because of the aging process. Consequently, maintaining a healthy lifestyle in the golden years often requires scaling back one’s drinking habits-to a weekly intake of seven drinks or less, according to recommendations from the National Institute on Alcoholism and Alcohol Abuse.

But tell that to an aging parent who is accustomed to several glasses of wine every night, and chances are that you’ll draw some ire. While some of this touchiness may be unavoidable, the following tips and guidelines can ease a conversation about drinking-related concerns with an aging parent:

Pick the right time to talk. As a good rule of thumb, “the right time” for a conversation about your parent’s alcohol use will not be when they are drinking. If their habit is to polish off a bottle of wine in the evening, choose an earlier time in the day to broach the subject. If you’re noticing signs of alcohol abuse-a morning hangover, for example-the best time to talk with your parent may be when they’re experiencing the negative side effects of their drinking. In that state, they may be more open to seeing how their drinking is adversely impacting their health.

Arm yourself with the facts. Because of aging-related differences in how the body metabolizes alcohol, just two or three beers at age 70 have about the same impact as four or five beers at the age of 50, according to Dr. David Oslin, M.D., in a 2010 article in the New York Times. “The effect almost doubles,” Dr. Oslin said, with the result that a seemingly moderate intake of alcohol can lead to insomnia, depression, exacerbated arthritis pain and heart damage, among other serious conditions. These dangers are compounded by the fact that many doctors do not sufficiently screen older patients for alcohol and other drug use-so it is safe to assume that your parent may not be aware that a long-held drinking habit may pose new health risks in their golden years. They also may not realize that alcohol may interfere with one or more of the medications they take and that in some cases the combination may be toxic. Sometimes, simply laying out these facts for an older parent will be enough to motivate them to rein in their alcohol consumption.

Open the conversation with a question. This way you convey your concern honestly and directly, but in a gentle, non-confrontational style that invites (and shows that you value) your parent’s feedback. A good lead-in question might be, for example, “Have you talked with your doctor about the medications you’re taking and their interactions with alcohol?”

Avoid labeling or diagnosing the problem. Even if it is an accurate description of your parent’s drinking habits, addiction terminology like “alcoholism” or “alcoholic” is not helpful because of the heavy stigma it carries. Using these labels can amplify your parent’s sense of shame or embarrassment about their drinking. (After all, if their alcohol consumption is causing negative consequences, they will have at least some awareness of the problem-even if they can’t admit it to you.)

Be specific about your observations and concerns. The caution to avoid labeling or diagnosing your parent’s problem should not require that you be silent about your observations and concerns. Just because your mom or dad is elderly does not mean they need to be coddled or protected from the truth. On the contrary, it is perfectly appropriate to say, “I am concerned about your drinking, because of x, y, z.” You can convey your concerns in a gentle and respectful tone.

Focus on the present, by identifying positive incentives for adopting a healthier alcohol intake. Even at an advanced age, the promise of better health and quality of life-and making the most of the time that is left-can be compelling motivation to modify one’s drinking habits. Try to emphasize the things that you know give your parent joy in the present, and that will give them even more joy when alcohol is less of a crutch. Whether it’s spending time with grandchildren, pursuing a romantic flame, or learning a new hobby in retirement, something else is worth more to Mom or Dad than their drinking ritual. By bringing that “something else” to their attention and encouraging them to pursue it, you’ll be sending the message that you love your parent and want them to be happy and healthy. It is hard to think of anything more persuasive than that.

Anna Ciulla is the Vice President of Clinical and Medical Services at Beach House Center for Recovery where she is responsible for designing, implementing and supervising the delivery of the latest evidence-based therapies for treating substance use disorders. Anna has a passion for helping clients with substance use and co-occurring disorders achieve successful long-term recovery.

When Roles Reverse: Talking to Parents About Alcohol

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Am I Too Old for Drug or Alcohol Rehab?
Conditions & Treatments

Am I Too Old for Drug or Alcohol Rehab?

by Kimberly Johnson
written by Kimberly Johnson

Why Seniors Should Consider Rehab an Option

Contrary to popular belief, addiction is not just an affliction of the young. More than 1 million adults ages 65 and older in this country have a substance use disorder, according to 2017 data from the Substance Abuse and Mental Health Services Administration (SAMHSA). This number is projected to rise, with a vast majority of affected seniors never seeking treatment in what has been aptly termed “a growing, but mostly silent, epidemic” in a 2016 study from BMC Health Services Research. Am I Too Old for Drug or Alcohol Rehab?
Sadly, what many older people with addiction don’t know is that rehab is both a viable and promising option for kicking a drug or alcohol problem. Seniority should never be an obstacle to getting effective treatment for an addiction.
 

Why Older Adults Should Go to Rehab

First, consider these three compelling reasons to go to rehab for a drug or alcohol problem.

  1. Older adults have better rates of recovery.

A 2013 Hazelden reportsheds light on why this is so. Recovery rates in seniors are higher than those in younger people because “older adults have more positive experiences to draw upon and tend to be more disciplined about recovery.”
Another key predictor of success in recovery is a client’s adherence to a plan of drug or alcohol treatment. When researchers in a 2002 studycompared older clients’ adherence to alcohol treatment with younger clients’ adherence to alcohol treatment, they found the older clients were more likely to comply with their plan of treatment. They were more faithful about attending therapy sessions and taking prescribed medications. As a result, the older adults’ rates of relapse were lower than those among younger adults.

  1. Drugs and alcohol are more physically harmful in older age.

There are a number of reasons that a drug or alcohol problem that you may have successfully managed earlier in life is increasingly more dangerous to your health as you age. These include:

  • A changing metabolism that raises your risks of a drug or alcohol-related fall or injury.
  • An age-associated decline in your immune system, cognition and other physical functions.
  • Your need for more over-the-counter medicines and doctor prescriptions as you age, accompanied by a greater likelihood of harmful interactions.
  • Decreased mobility and social interactions that can feed your sense of isolation and contribute to more severe substance abuse and addiction
  1. There is no better time than now (the “Golden Years”) to improve your quality of life.

Contrary to the ageist mindset that says you’re too old to benefit from rehab, seniority is a persuasive reason to put quality-of-life concerns first. The golden years are an opportunity to make the most of the time you have left. Researchshows that people who attend inpatient rehab achieve a significant improvement in their quality of life.
For older people, moreover, positive and supportive relationships— not finances— are reportedly a more important quality-of-life measure. Strikingly, there is an even greater body of research that describes how treatment for addiction can improve close relationships with family and friends.

Tips for Finding the Right Rehab Program

Seniors who pursue treatment for an addiction have a number of rehab programs to choose from. Some cater exclusively to seniors, such as a nursing home that integrates addiction treatment into post-hospital rehab.
But don’t rule out a mixed-age rehab program either. Findings from the 2002 study cited above suggested that individualized, age-appropriate psychotherapies are more important to a successful recovery than a seniors-only treatment setting.
Here are some other things to keep in mind when you’re looking for a rehab program:

  • Detox time– Detox typically takes longer in older adults, so look for a program that will provide you with a medically supervised withdrawal that is safe and complete.
  • Dual diagnosis program– Substance abuse in older adults can often co-occur with symptoms of anxiety or depression related to grief, loss of mobility and/or other life transitions that come with age. Look for programs that are “dual diagnosis” (meaning they treat both substance use and co-occurring disorders).
  • Customized therapies for your psychosocial needs– Similarly, substance abuse typically has psychosocial and emotional roots that need to be addressed. Among older adults, these may relate to issues like depression or complicated or unresolved grief. Ask about what sorts of therapies will be offered to address these sorts of issues, and to what extent these therapies will be provided on an individual basis.
  • Location of program– If you have age-related health and mobility issues, you may wish to stay closer to home for rehab. Alternatively, if you’re able to travel, a program that is out of state may provide you with more of a retreat-like experience.
  • The tone of the staff towards older adults– Try to gauge whether there is a tone of positive support, respect and care for older adult clients. Pay attention to how the staff responds to your requests and inquiries when you call or tour the facility. If you pick up on any age-related condescension, that’s an immediate red flag.
  • Length of treatment– No matter your age group, you’ll experience better recovery outcomes the longer you stay in treatment, so ask about the length of the program.

No older adult should forego treatment because of concerns about their age. If you’re young enough to drink or use drugs, you’re young enough for rehab. Period.
By Anna Ciulla
Anna Ciulla is the Vice President of Clinical and Medical Services at Beach House Center for Recovery, where she oversees the supervision and delivery of client care. Anna has an extensive background in psychotherapy and clinical management and is often invited to speak and write for various audiences on issues related to addiction. She writes on a variety of addiction and recovery-related topics, including the benefits of seeking treatment no matter your age or place in life.
Support Systems for Elderly Dealing with Substance Abuse

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