Best Practices: Treatment and Rehabilitation for Seniors with Substance Use Problems

2. Review of the Literature (continued)

2.2 The Aging Population

2.2.1 Aging Process

Many transitions occur as people age, but physical changes are the most readily apparent. The media has tended to portray aging in a negative manner, as evidenced by gray-haired people in denture adhesive and incontinence product commercials, and the absence of gray-haired individuals in what are stereotypically positive roles (Birk, 1996). However this is now changing somewhat, and for many seniors there are benefits to aging such as retirement, grown children, grandchildren, lifelong friends, and satisfaction with life's journey.

Later life can be a period of onset of certain chronic conditions (e.g., osteoporosis, type-2 diabetes). Certain physical and physiological changes are likely. Hair turns gray, bones and joints lose density, lean body mass gradually turns to body fat, and vision and hearing losses may occur. Physical abilities may gradually decline and medical problems tend to increase. High blood pressure, hormonal and gastrointestinal difficulties may surface for the first time (Baron & Carver, 1997; Gomberg & Zucker, 1998; Spencer & Hutchinson, 1999).

Cognitive changes can also occur and dementia is found in 10% of persons over the age of 70 (Woods, 1996). Some people may experience depression, anxiety, sleep disorders, or a sense of loss of control over their life as a reaction to the aging process and its demands. These changes are often attributed to aging when they may actually be caused by substance use problems (Gambert, 1997).

2.2.2 Symptoms of Chronic Conditions or Substance Use Problems

Prolonged substance use, intoxication, or withdrawal can induce symptoms that may be misattributed to chronic conditions (Dufour & Fuller, 1995). Some researchers speculate that a bias exists in the healthcare industry that predisposes physicians and others to attribute confusion and injury in the elderly to aging rather than to possible substance use problems (Gambert, 1997). Reasons for under-diagnosis and mis-diagnosis can relate both to stereotypical expectations of seniors' behaviour that precludes attributing problems to substance use, and to a reluctance on the part of seniors to be open about the problem. Birk (1996) asserts that excessive drinking carries a stigma, and seniors may be more reticent about discussing personal matters when they have been self-reliant in the past.

2.2.3 Age-related Changes and Substance Use

According to Smith (1995), seniors are more susceptible to the effects of alcohol due to physiological changes. These changes include:

• the percentage of body fat increases in proportion to total body weigh;
• the amount of lean body mass decreases; and
• the total volume of water in the body diminishes.

Because alcohol is a water soluble compound and there is less water available to dilute its effects, alcohol will have more potency in seniors (Dufour & Fuller, 1995; Smith, 1995).

Lucey et al. (1999) altered the conditions surrounding alcohol intake in younger (21 to 40 years) and older (60 years and more) males and females. Participants were administered alcohol orally after fasting eight hours, orally after eating a meal and intravenously after eating a meal. Blood samples taken after each test condition revealed faster blood alcohol absorption in older participants in the oral-fasted condition and the intravenous-fed conditions, but not in the oral-fed condition. Another significant finding was that contrary to expectations, alcohol ingested orally on an empty stomach resulted in faster blood alcohol absorption than alcohol injected intravenously into a fed participant. The outcomes of this study support the notion that proper nutritional intake will mitigate the effects of alcohol and lack of food intake will intensify these effects in the senior.

Spencer and Hutchinson (1999) examined how alcohol intoxication increases production of stress hormones and how these hormones lead to premature aging. Although many people drink in order to relieve anxiety or stress, elevated blood alcohol levels actually stimulate secretion of stress hormones called glucocorticoids. The continual stimulation of this class of stress hormones causes physiological and neurological degeneration associated with aging. This may be the cause of the premature aging that is sometimes observed in those which chronic alcohol problems.

Age-related physiological changes slow the metabolic (liver and kidney) activity that breaks down chemical substances, resulting in prolonged effects on the central nervous system and greater susceptibility to problem substance use (Solomon, Manepalli, Ireland & Mahon, 1993). One example of this is "drug dependency insomnia" which occurs when misuse of sleep medication creates a sleep disorder. Acute tolerance to sleep medication builds quickly, and in response, the person takes larger and larger quantities of the drug to combat the insomnia, so becomes dependent (Barnea & Teichman, 1994). As with all age groups, seniors are susceptible to this condition.

2.2.4 Losses and New Roles

Each individual will react to the challenges of aging in a unique manner depending upon their biological, emotional, mental and social strengths. New roles as caregivers for spouses or elderly parents, geographic relocation or the development of new relationships require adjustments and adaptations. Some of the challenges associated with loss include:

• the death of spouses, family or friends;
• retirement;
• changes in the family structure; and
• failing physical or mental health (Birk, 1996; Ruben, 1992).

According to a 1981 US National Council on Aging survey, "income, social interaction and activity levels are the variables that have the greatest impact on perceived quality of life following retirement" (Birk, 1996, p. 387). Upon retirement, spouses may need to adapt to being home together. While retirement is often expected to be a time of relaxation and release from stressors, it can constitute a significant source of stress because it demands adjustment to new roles (Norton, 1998).

According to Anetzberger & Korbin (1994), one major challenge for adults involves their role as caregivers for elderly parents. Due to a longer life span, some seniors will find themselves responsible for the care of elderly parents. The demands of being a caregiver after retirement adds to any existing stress (Anetzberger & Korbin, 1994; Birk, 1996).

Another potential stress occurs when geographic relocation is required due to personal health, family circumstances or economics. Such a move can mean a loss of the existing social support network and perception of the move as a positive or negative event will influence overall personal happiness. Approximately 75% of retired people prefer to stay in their own homes as long as they are able (Birk, 1996). If they do move, they may be confronted by the challenge of making new friends and building a new social structure.

Remarriage may also present a challenge to some individuals as they adapt to new partners and new social and family networks. While this change may be rewarding, it may also engender feelings of guilt or distress (Birk, 1996).