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Not in the Holiday spirit: The Role of alcohol in Elder Abuse

by Charmaine Spencer

The argument reached its peak just after Christmas dinner. Nancy had been drinking at the time when she struck her 68 year old mother across the face. Nancy apologized almost immediately, but it's not the first time this has happened, and probably won't be the last.

John has been a heavy drinker most of his 75 years. It has taken a toll on him, physically and emotionally. The only person who keeps regular contact with him now is the taxi driver who takes him for groceries and to the liquor store. After yet another of his "special nights out" with the driver, John's wallet is $800 lighter, and he has no recollection of where it might have gone. His bank card is missing.

The role of alcohol dependency in abuse is well known in research on family violence. It is linked to physical abuse, chronic verbal aggression, or financial exploitation. So perhaps we should not be surprised to find that alcohol dependency is also the most commonly cited risk factor in abuse of older adults. What may be surprising is that most community resources dealing with abuse of older adults do not address the alcohol issues.

The Use of Alcohol as a Coping Strategy:

In our culture, alcohol, street drugs and prescription drugs are widely used coping strategies for dealing with personal, social and environmental stresses. Young and middle aged adults may use alcohol or other drugs as an escape valve for financial, family relationship, caregiving, or (un)employment pressures. Older adults may turn to alcohol upon retirement; death of spouse or divorce; or when there is a negative change in their financial circumstances. Many older adults are prescribed psychoactive medications as they struggle with changes in their own physical and mental health or that of their spouse; the death of friends and family, or relocation (moving from the family home or into a long-term care facility). The pressures can feel overwhelming, and alcohol or medication provides a quick release.

When the Abuser has an Alcohol or Other Drug Problem:

In the general population, about 9.2% of adults acknowledge that alcohol is adversely affecting their life. The figures are likely much higher, as many people do not acknowledge the extent of the problem in their lives until it is far advanced.

Alcohol problems among people who abuse older adults is common. A 1990 study looking at substantiated older adult abuse cases reported to authorities, found that 44% of the sons and 14% of the daughters committing the abuse had alcohol problems. Several studies looking at abuse of older adults in the last few years have found that the abusers are more likely to drink alcohol, drink more frequently and more heavily than non-abusers.

When an Abused Senior Has an Alcohol or Drug Problem:

We tend to think that older adults do not drink, or that they seldom drink to excess. While this is the case for the majority of seniors, between 6 and 10% of seniors in B.C. have alcohol problems (or 29,000-48,000 seniors). This is a relatively high percentage in light of the fact that almost 4 out of 10 seniors do not drink. For certain groups, the percentage of seniors with alcohol problems is three to four times higher - e.g. among older hospital inpatients, and seniors with mental health problems.

Many Canadian seniors tend to drink on a regular basis (22% of seniors consume alcohol four or more times a week, compared to 11% in the general population). Older adults tend to drink at home, not in public. Older adults with an alcohol problem tend to withdraw when they drink; they become passive or passive aggressive.

There are several reasons for the relatively high rate of alcohol abuse among seniors. First, people's bodies are less able to metabolize alcohol and other drugs as they age. For example, a healthy sixty year old male will show a blood alcohol level 20% higher than that of a man under the age of 45, even though they consumed the same amount of alcohol. As a result, an older person can become alcohol dependent if regularly using what would be moderate amounts or small amounts of alcohol for a younger adult.

Second, many seniors rely on multiple prescription drugs. There are at least 150 drugs commonly prescribed for seniors that have a significant interaction with alcohol. These include anti-diabetic agents, nitroglycerin, and psychoactive agents. Therapeutic doses of anti-anxiety drugs, tranquillizers, or anti-depressants will enhance the depressant effect of the alcohol.

Third, the alcohol and prescription drug problems among seniors often go unrecognized until there is a crisis. The general public, professionals and seniors all have strong stereotypes regarding what sort of person develops alcohol problems. In a recent study of physicians' attitudes, a majority of physicians described the typical person with an alcohol problem as "male, unemployed, and not living up to his family responsibilities." Seniors, and particularly older women, were far less likely to be recognized as having alcohol or prescription drug problems.

Alcohol's Role:

At this point, while we know that there is a connection between alcohol and abuse, the nature of the connection is still unclear. Alcohol use does not cause the violence or the psychological abuse, but it helps set the stage for it. Abusers often use their inebriation as a way of rationalizing their behaviour ('I was drunk at the time, I didn't know what I was doing'). Alcohol may act as a disinhibitor. However, some abusers get drunk in order to abuse.

Research indicates that younger people with alcohol problems tend to be more hostile, impulsive and aggressive than non-alcoholics are. It is not clear whether this also holds for older people with alcohol problems or for both sexes. People who have alcohol problems often experience low self esteem, loss of impulse control, quick tempers, anger, guilt, anxiety and depression. Psychological abuse by a chemically dependent person often takes the form of rationalizing, degradation, humiliation, and threats. Longstanding alcohol problems between adult children and their parents may foster a psychological dependency between them.

A person who has a substance abuse problem can experience continuing financial crises, particularly if the problem is affecting his or her ability to get and keep a job. The nature of the chemical dependency means that the person may go after money for alcohol or drugs, exploiting whatever source is most readily available. As a result, theft or fraud perpetrated against family members can be common. In some cases, that source is a senior.

Case file review of the Seniors Well Aware Program, (an outreach program in the Lower Mainland serving clients who have alcohol or other substance dependency problems) indicates that approximately 20% of their clients experience some form of abuse. Other outreach programs have found similar rates. For some seniors, alcohol and prescription medications become the person's way of coping with abuse experienced much earlier in life (child abuse, rape, wife assault), or abuse that is currently happening. For other seniors, the alcohol or prescription drug use has impaired the person's memory or judgment, leaving him or her more vulnerable to abuse by others, and making it harder for the person to access and benefit from any available community resources.

Getting Help and Giving Help:

Both alcohol problems and abuse problems involving older adults can be extremely challenging. When alcohol is involved, community agencies tend to avoid the issue. People often feel ill-equipped to help abused seniors in these circumstances. The cases are often complex and they take considerable time to resolve. In many instances, people treat alcohol or drug issues as "personal or private". The "hands-off approach" is further complicated by the fact that when street drugs are involved, practitioners sometimes fear for their personal safety.

Also, many people have the mistaken belief that those with alcohol or other substance abuse problems cannot be helped. However, there are a number of things that can be done in terms of offering help in the circumstances both for the abused senior and the abuser. It is important to realize that there are two different people involved-- the abuser and the senior. They may have common, opposing, or overlapping needs that need to be addressed independently.

The first step is always to ask the senior about alcohol problems, drug use, illness, behaviour problems among household or family members in a respectful, non-judgmental manner. We suggest wording like:

"Is there anyone you know who has problems with alcohol or drugs?"

If the answer is yes, then ask whether they are ever concerned about the person's ability to control their temper. This is not a 'one shot deal'. A senior initially may be reluctant to disclose these kinds of problems, and it takes time and effort to develop a trusting relationship. Once that happens, then you are in an excellent position to clarify the senior's legal rights, and service options for him or her. This will help assure that the senior has accurate information on which to make informed choices regarding his or her self protection, and ways of helping the family member.

If an abused senior appears to have an alcohol or prescription drug problem, probe gently. Express concern, but do not confront the person about the substance abuse. Do not use words like "alcoholic" in reference to the senior. Instead, use words like words like "problem drinking" or "troubles with your medication". The social stigma is extremely strong for seniors.

Know your community resources. In particular, learn if there are alcohol or other substance abuse programs available specifically for seniors. Research has consistently found that seniors who have alcohol or prescription drug problems do much better in age-specific programs. Community resources such as AA may only help a small proportion of seniors. Many seniors with alcohol or prescription drug dependencies often have significant health and mobility problems that make it extremely difficult for them to access the resource, or it may not meet their other needs.

Seniors are best helped when the people offering service are knowledgeable about both addiction issues and aging issues. If such a service isn't available in your community, advocate for its development. These are important first steps to helping address two significant social problems.