Substance Abuse December 2004

Substance abuse affects elders directly and indirectly. Research suggests that elders who abuse substances are at greater risk for self-neglect and may be more easily exploited and abused by others. Research also indicates that victims of abuse and those coping with post-traumatic stress symptoms may chose to self-medicate with drugs and alcohol. Furthermore, healthcare professionals are less likely to screen seniors for drug or alcohol abuse. Not only does this perpetuate the under-diagnosis of substance abuse in elders; it is a missed opportunity for screening for elder abuse and neglect. Due to age related changes, the use of drugs or alcohol in smaller amounts can have a significant impact upon the health of older individuals. Substance abuse has also been identified as a characteristic of the abuser profile.

The following references highlight many of the complexities of identifying and addressing substance abuse among the elderly. Most of these reference materials may be obtained through your local university and community libraries or interlibrary loan services. Some must be ordered directly through the publisher or production company. When available, contact and pricing information is included with the abstract. Increasingly, many resources are available online, and the web addresses are also included.* If you have difficulty obtaining any of these materials, please contact the CANE office for assistance.

CANE is a service of the National Center on Elder Abuse (NCEA) which is supported by a grant from the Administration on Aging.

(*Web addresses may change without notice. If an address provided is no longer accurate, we recommend using a generic search engine, such as Google, to find a current link. If you cannot locate the online publication, contact the CANE offices for assistance.)

2004

1. P5734-00
Center for Substance Abuse Treatment (CSAT), for the Substance Abuse and Mental Health Services Association (SAMHSA), U.S. Department of Health and Human Services (HHS)
The Road to Recovery: Addiction by Prescription
Center for Substance Abuse Treatment (CSAT), for the Substance Abuse and Mental Health Services Association (SAMHSA), U.S. Department of Health and Human Services (DHHS); March 3 2004.
Video/webcast
This video, also available as a webcast through the SAMHSA web site, presents an overview of the problem of prescription medication abuse and addiction. Abuse and misuse of narcotics, anti-anxiety medications, stimulants, and sedatives are described. A portion of this webcast addresses several issues related to prescription medication abuse among older individuals. Therapeutic and pharmacological interventions are highlighted. (This webcast can be accessed online at http://www.recoverymonth.gov/2004/multimedia/w.aspx?ID=245. The video may be purchased by contacting SAMHSA at 1-800-729-6686. Price: $12.50. Inventory Number: VHS182)

2. P5735-00
Center for Substance Abuse Treatment (CSAT), for the Substance Abuse and Mental Health Services Association (SAMHSA), U.S. Department of Health and Human Services (HHS)
Rethinking the Demographics of Addiction: Helping Older Adults Find Recovery
Center for Substance Abuse Treatment (CSAT), for the Substance Abuse and Mental Health Services Association (SAMHSA), U.S. Department of Health and Human Services (DHHS); May 5 2004.
Webcast
This webcast addresses a wide range of problems associated with substance abuse among older individuals. The host, Ivette Torres (Associate Director for Consumer Affairs, CSAT, SAMHSA, HHS) and expert panelists (David Oslin, Assistant Professor of Psychiatry at the University of Pennsylvania Medical Center and the Philadelphia Veterans Affairs Medical Center; Doris Terry, Former State Supervisor of Health Education for the MD State Dept of Education; Carol Colleran, Director, Hazelden Foundation; James Firman, President and CEO, National Council on the Aging) describe problems in identification unique to the older population. Physicians and other health care and social service professionals are advised to be aware of the possibility of prescription drug misuse and addiction and alcohol abuse when assessing patients over 60, especially in the presence of new symptoms. Intergenerational dynamics are also considered. Stories of recovery are highlighted, along with promising practices in intervention. (Note: This webcast, available online through the SAMHSA web site as part of the Road to Recovery series, is accessible only at: http://www.recoverymonth.gov/2004/multimedia/w.aspx?ID=252.)

3. P5588-2
Downing, N.
Prism-E Study Links Primary Care to Elders' Mental Health
Aging Today; Vol. XXV (2); March/April 2004.
Newsletter article
The Primary Care Research in Substance Abuse and Mental Health for the Elderly (PRISM-E), initiated by the Substance Abuse and Mental Health Services Administration (SAMHSA) in 1998, is intended to foster the utilization of mental health and substance abuse services by older patients within health care settings such as the primary care practice. In this study, over 25,000 adults aged 65 and over were screened for depression, anxiety and at risk drinking. Two thousand-two hundred patients were identified and assigned to either an integrated service treatment approach or a referral service model. Participants were assessed at three, six and twelve month intervals to document clinical, access and cost outcomes. Fourteen percent of adults screened demonstrated symptoms of depression, anxiety, or both, and six percent were at risk for alcohol abuse. Thirty-eight percent of these patients experienced suicidal or death ideation. Results indicate that 71 percent of the patients assigned to the integrated model engaged treatment services, while only 49 percent of the referral service group engaged treatment services.

4. P5499-8
Hajat, S., Haines, A., Bulpitt, C. & Fletcher, A.
Patterns and Determinants of Alcohol Consumption in People Aged 75 Years and Older: Results from the MRC Trial of Assessment and Management of Older People in the Community
Age and Ageing; Vol. 33 (2), 170-177; 2004.
Journal article (research)
In this study, ninety-seven percent (n=14,962) of the patients aged 75 and older of the 53 randomly assigned practices that constituted the universal arm of the Medical Research Council General Practice Research Framework completed questions regarding alcohol consumption. The median participant age was 80.3 years, and 62 percent of the respondents were female. Of the findings, 5 percent of the men and 2.5 percent of the women exceeded the alcohol intake levels recommended by the Royal College of Physicians, Psychiatrists and General Practitioners, while 17 percent reported never having had a drink. The participants who drank reported having a fairly active social life as well as relatively good health. The findings suggest that moderate consumption appears associated with relative financial security. (U.K./England)

5. P5706-10
Moos, R., Schutte, K., Brennan, P. & Moos, B.
Ten-year Patterns of Alcohol Consumption and Drinking Problems among Older Women and Men
Addiction; Vol. 99 (7), 829-838; 2004.
Journal article (research)
This study analyzes changes in patterns of alcohol consumption among older women and men, and considers late-life and life history predictors of alcohol related problems. A sample of 1,291 community residents, aged 55-65, who had consumed alcohol within the preceding year were assessed at baseline, then at one, four and ten year intervals. Frequency and greatest daily amount consumed and drinking problems experienced within the past year were measured. In addition, medical conditions, psychoactive medication use, negative life events and avoidance coping were also assessed. Over time, the proportion of individuals (male and female) who consumed alcohol declined along with amount consumed. Predictors identified for greater risk of late-life drinking included history of heavy drinking, history of drinking problems, smoking, avoidance coping, and friends' approval of drinking.

6. P5708-6
Mukamal, K. et al.
Self-Reported Alcohol Consumption and Falls in Older Adults: Cross-Sectional and Longitudinal Analyses of the Cardiovascular Health Study
Journal of the American Geriatrics Society (JAGS); Vol. 52 (7), 1174-1179; 2004.
Journal article (research)
This research, drawing upon data from the Cardiovascular Health Study, provides a cross-sectional and longitudinal analysis of associations between alcohol consumption and risk of falls in the elderly. The sample consisted of 5,841 participants who, at the baseline assessment, were physically examined, had gait speed and maximal grip strength measured, reported upon alcohol consumption (including frequency and changes in patterns), and reported upon falls. Follow-up occurred at six month intervals for four years, alternating between clinical visits and telephone contact. Among the results, while a cross-sectional analysis suggests an apparent inverse association between consumption and falls, the longitudinal analysis suggests that older individuals who consume 14 or more drinks per week are at greater risk for experiencing falls.

7. P5739-5
Office of Applied Studies, for the Substance Abuse and Mental Health Services Administration (SAMHSA), U.S. Department of Health and Human Services (HSS)
Older Adults in Substance Abuse Treatment: 2001
The DASIS Report (Drug and Alcohol Services Information System); May 11 2004.
Online report
This report indicates that in 2001, there were 58,000 substance abuse treatment admissions for individuals aged 55 and older in the U.S. Those admitted were more likely to be White, self-referred, and nearly two-thirds of those admitted abused alcohol with no secondary drug abuse reported. (Note: This report can be accessed online at http://www.oas.samhsa.gov/2k4/olderAdultsTX/olderAdultsTX.cfm.)


2003

8. P5122-8
Akaza, K. et al.
Elder Abuse and Neglect: Social Problems Revealed from 15 Autopsy Cases
Legal Medicine; Vol. 5 (1), 7-14; 2003.
Journal article (research)
This retrospective study examined cases of individuals aged 65 and older who died and were autopsied from 1990 through 2000 in the Department of Legal Medicine at the Gifu University School of Medicine in the prefecture of Gifu, Japan. The analysis revealed that in the sample of 125 cases, 15 deaths were attributed to elder abuse and neglect. Among the 13 domestic cases classified as abuse, the perpetrator was most often the victim's son. Eight of the perpetrators were unemployed, four had a history of mental illness, and two were alcoholics. Each case is briefly described. In seven cases, criminal investigations were initiated and three perpetrators were psychiatrically hospitalized.

9. P5376-3
Knauer, C.
Geriatric Alcohol Abuse: A National Epidemic
Geriatric Nursing; Vol. 24 (3), 152-154; May-June 2003.
Journal article (scholarship)
Thirteen percent of men and 2 percent of women aged 60 to 94 report heavy use of alcohol. As the body ages, the effects of alcohol are compounded. This article addresses the primary care practitioner's role in assessing and addressing alcohol abuse in geriatric patients. A comprehensive history and physical, including a screening for alcohol use, is essential. Not only should physicians be concerned with the increased likelihood of medication interactions with alcohol use and an increased risk for falls, but substance abuse within either the patient or a caregiver creates a higher risk for elder abuse. The article offers guidelines for nurses and other practitioners seeking referral resources for older patients, including the use of the Health and Human Services' Substance Abuse and Mental Health Services Administration (SAMHSA) web site listing of regional treatment and support programs.

10. P5395-12
Masters, J.
Moderate Alcohol Consumption and Unappreciated Risk for Alcohol-Related Harm Among Ethnically Diverse, Urban-Dwelling Elders
Geriatric Nursing; Vol. 24 (3). 155-161; May-June 2003.
Journal article (research)/online
A number of factors (including ageism, poor symptom detection, and a lack of knowledge about screening techniques) contribute to the under-recognition of alcohol abuse in older individuals, a growing public health concern. As the threshold for alcohol-related risk decreases with age, geriatric patients are at increased risk for health complications and polypharmacy interactions due to alcohol abuse. Differences in defining levels of consumption adds to the difficulty of detection. The goal of this study was to assess how older adults define moderate alcohol use. A convenience sample of 107 ethnically diverse, urban-dwelling individuals aged 50 and over, was surveyed as to how they defined and quantified moderate alcohol consumption, and whether media messages have affected their beliefs. The most significant result is that many participants define moderate alcohol use at higher levels than the federal guidelines. Differences within ethnic groups are discussed. The underappreciation of alcohol-related risk underscores the need for careful screening on the part of physicians and other health care professionals and the CAGE screening tool is discussed. Included is a chart describing a number of medications that cause extremely adverse, disulfiram-like reactions when taken with alcohol. (Note: This article is accessible online at Medscape.com. A no-fee registration is required.)

11. P5299-8
Porcerelli, J. et al.
Violent Victimization of Women and Men: Physical and Psychiatric Symptoms
Journal of the American Board of Family Practitioners; Vol. 16 (1), 32-39; January-February 2003.
Journal article (research)
The two objectives of this exploratory study were to assess the prevalence of violent victimization of both men and women among family practice patients, and to compare the physical symptoms, alcohol abuse issues and depression of those recently victimized with those not victimized during the previous year. Participants were recruited from four family practice clinics (three residency-training clinics and one faculty clinic) in the Detroit area. All adult patients were approached, and the final sample included 679 women and 345 men aged 18 to 64. Participants completed a demographic questionnaire, along with portions of the Milcom Health History Update and Physical Examination the Brief Conflict Tactics Scale. Researchers also asked respondents to indicate the relationship(s) victims had with abusers. Of the findings, 9.9 percent of female participants and 10.9 percent of male participants reported severe violent victimization during the previous year, and 4.9 percent of the females and 3 percent of the males reported abuse by partners. Almost one-third of those victimized were victimized by more than one perpetrator and these individuals reported higher rates of alcohol abuse. Women victimized and men victimized by partners reported more depressive symptoms. (Not specific to elder abuse.)

12. P5484-12
Rennison, C. & Rand, M.
Nonlethal Intimate Partner Violence - A Comparison of Three Age Cohorts
Violence Against Women; Vol. 9 (12), 1417-1428; December 2003.
Journal article (research)
This article provides a comparison of data from the National Crime Victimization Survey (NCVS, 1993-2001) regarding the prevalence and incidence estimates of nonlethal intimate partner violence (IPV) among three age cohorts: women aged 55 and over, those aged 25 to 54, and those aged 12 to 24. Females aged 12 to 24 had the highest rate of intimate partner victimization (12.3 per 1000); the 25 to 54 cohort were victimized at a rate of 8.7 per 1000; and women aged 55 and older were victimized at a rate of .44 per 1000. Older women were most often victimized by a current spouse (62 percent), and nearly half of the mature women victimized indicated that their perpetrator was under the influence of alcohol or drugs. Ninety-four percent of the IPV of older women occurred in their homes. Only 52 percent of the nonlethal IPV perpetrated against older women was reported to the police. Researchers discuss possible reasons for under-reporting among older women, among other considerations.

13. P5217-8
Shugarman, L., Fries, B., Wolf, R. & Morris, J.
Identifying Older People at Risk of Abuse During Routine Screening Practices
Journal of the American Geriatrics Society (JAGS); Vol. 51 (1), 24-31; 2003.
Journal article (research)
This study explored the links between various characteristics of older, community-dwelling individuals and the potential for elder abuse. Research was based upon data from 701 application interviews from the Michigan Home and Community Based Services (HCBS) waiver program and the Care Management program (November 1996 - October 1997). Five measures of elder abuse and neglect were used to identify those potentially victimized, and characteristics were analyzed to determine if an association was suggested. Thirty-three of the 701 demonstrated at least one of the signs of potential abuse. Short-term memory, psychiatric illness, alcohol abuse, and four measures of poor social functioning and impaired support were associated with the potential for mistreatment. While this index had a high degree of sensitivity for identifying potential abuse, it did not appear to have a high degree of specificity. The researchers suggest health care professionals combine these indicators with key questions from the Minimum Data Set for Home Care (MDS-HC) for screening and care planning.

14. P5200-7
Simon, S. & Gurwitz, J.
Drug Therapy in the Elderly: Improving Quality and Access
Clinical Pharmacology & Therapeutics; 73 (5) 387-393; May 2003.
Journal article (scholarship)
This article addresses the use of inappropriate drugs, the inappropriate use of drugs, and the underutilization of potentially beneficial medications in the elderly. While there has been a decline in the use of inappropriate medications, there are approximately 1,900,000 adverse drug events among Medicare enrollees annually, 180,000 of which are life-threatening or fatal. These events, many preventable, typically occur as a result of how the drug is administered (drug interactions, inaccurate dosage, etc.) Underutilization of medication in the following conditions has been observed in treatment of the elderly: asthma, cardiovascular disease, hypertension, dyslipidemia, stroke prevention, osteoporosis prevention, pain management and depression. The exclusion of older patients in clinical trials regarding medication forces physicians either to under prescribe certain medications, or to prescribe without adequate evidence of efficacy and safety. One significant barrier to underutilization of appropriate medications is the lack of prescription coverage for many seniors. Computerized Physician Order Entry (CPOE) systems are described as one possible means of enhancing coordination of prescription management throughout various aspects of health care that would improve the quality of pharmaceutical use.

15. P5597-11
U.S. Department of Health and Human Services (DHSS), National Council on the Aging, (NCOA), Administration on Aging (AoA), Substance Abuse and Mental Health Services Administration (SAMHSA)
Get Connected! Linking Older Adults with Medication, Alcohol, and Mental Health Resources
U.S. Department of Health and Human Services (DHSS), Administration on Aging (AoA), Substance Abuse and Mental Health Services Administration (SAMHSA); 2003.
Resource packet
This tool kit is designed to help providers in aging services address issues related to medication misuse, substance abuse and emotional problems among older people. It includes fact sheets, a video, consumer brochures, training guides and curricula, and a services resource guide. To order, contact the Substance Abuse and Mental Health Services Administration (SAMHSA) National Clearinghouse for Alcohol and Drug information at 1-800-729-6686 or email info@health.org.

16. P5468-8
Yeaw, E. & Burlingame, P.
Identifying High-Risk Patients from the Emergency Department to the Home
Home Healthcare Nurse; Vol. 21 (7), 473-480; July 2003.
Journal article (research)
This article discusses the development of the High Risk Discharge Assessment Instrument (HRDAI) for use in the emergency department (ED) as well as in home care services. It was based upon the High Risk Fall Model (HRFM) since the retrospective study of medical records from an ED revealed that 65 percent of the admissions of patients 65 and over were due to falls. The tool identifies eight areas of potential risk: impaired mobility, living alone, mental status changes, the possibility of domestic violence or elder abuse, substance abuse, non-compliance, inadequate resources and repeat visits to the emergency room (ER). Composite scores indicate the suggested level of intervention, which range from further inquiry to social service referral (prior to or post-discharge) to the need for temporary nursing home placement. Early results indicate that the tool is effective in identifying patients in need of post discharge services, as researchers continue to test the tool in the Rhode Island hospital where it was developed. A copy of the HRDAI is included, along with guidelines for the adaptation of this process to home care nursing services.

2002

17. P5596-11
Bartels, S. et al.
Suicidal and Death Ideation in Older Primary Care Patients with Depression, Anxiety, and At-Risk Alcohol Use
American Journal of Geriatric Psychiatry; Vol. 10 (4), 417-427; July-August 2002.
Journal article (research)
This article discusses the risk factors associated with suicidal and death ideation based upon data from the Primary Care Research in Substance Abuse and Mental Health for the Elderly (PRISMe) study, which was designed to compare the integrative approach of mental health and substance abuse service delivery to the referral approach. The sample consisted of 2,240 primary care patients aged 65 and over who screened positive for a mental health disorder, suicidal ideation or at-risk drinking, who were not already receiving mental health or substance abuse services. Suicidal ideation was assessed by the five Paykel suicide questions. Subjects were categorized as having no ideation, death ideation, or suicidal ideation. Overall, one-third of the participants experienced either death or suicidal ideation. Based on the findings, researchers suggest that geriatric patients at greatest risk of suicidal ideation are those with moderate-to-severe depression, co-occurring depression and anxiety, those who are socially isolated, aged 65-74, and white or Asian. Although death ideation was associated with a higher incidence of co-morbid medical conditions and higher rates of health care service use (including ER visits and in-patient hospitalizations), no health care service usage patterns were observed to identify which primary care patients may be experiencing suicidal ideation. Researchers failed to find an association between at-risk alcohol use and suicidal ideation.

18. P5714-228
Beechem, M.
Elderly Alcoholism Intervention Strategies
Charles C. Thomas Publisher, LTD., Springfield, IL; 2002.
Book
This book (intended for students of gerontology, and health and social service professionals working with older individuals) presents an overview of alcohol abuse in elders. After describing the relatively brief history of the recognition of the problem, the author addresses such topics as the impact of alcohol abuse on the aging process and the problems in using traditional assessment and intervention strategies with seniors. One chapter is dedicated to providing culturally specific treatment for older people of color, gays and lesbians, and the homeless, and also discusses gender related treatment issues. Other chapter topics include practice values and attitudes, treatment strategies, spiritual issues, relapse, suicide, and model programs.

19. N4595-24
Fink, A., et al.
Comparing the Alcohol-Related Problems Survey (ARPS) to Traditional Alcohol Screening Measures in Elderly Outpatients
Archives of Gerontology and Geriatrics; Vol. 34 (1), 55-78; 2002.
Journal article (research)
In this study, 574 elderly patients at the UCLA Medical Center and Sansum-Santa Barbara Medical Foundation Clinics participated in a comparison of the newly developed Alcohol-Related Problems Survey (including an embedded version of the AUDIT) with two other well validated screening tools, the SMAST and the CAGE. The ARPS, which assesses the respondents' medical conditions and medication usage as well as patterns of alcohol usage, identified the respondents who scored positively on the other scoring tools. It also identified "hazardous" and "harmful" drinkers, due to the interaction of lower levels of alcohol consumption with medical conditions and medications that were not identified by the other tests. The implication is that this tool could be effective in the health care setting as a means to identify elderly patients at risk for alcohol related problems who were previously unidentified. The ARPS survey is included.

20. P5712-242
Gurnack, A., Atkinson, R. & Osgood, N., eds.
Treating Alcohol and Drug Abuse in the Elderly
Springer Publishing Company; New York, NY; 2002.
Book
This treatment-oriented book presents an overview of drug and alcohol abuse among seniors. Part I focuses on the identification and assessment of alcohol abuse and medication misuse and includes discussion regarding the interactive nature of alcohol and prescription drugs, and the mental and physical disorders of seniors who demonstrate at risk use or problem use. Part II presents a number of therapeutic strategies to address elder substance abuse, including cognitive-behavioral interventions and self-management approaches. Part III addresses other addictive behaviors, including smoking and problem gambling. (Note: This book is not available through CANE.)

21. P5599
National Council on Aging (NCOA) for the Substance Abuse and Mental Health Services Administration (SAMHSA), U.S. Department of Health and Human Services (HHS)
Promoting Older Adult Health: Aging Network Partnerships to Address Medication, Alcohol, and Mental Health Problems
U.S. Department of Health and Human Services (HHS), Substance Abuse and Mental Health Services Administration (SAMHSA); 2002.
Agency report
This publication profiles promising practices of 15 organizations linking supportive services with mental health and/or medication and alcohol misuse or abuse services to older adults. The initiatives are grouped into the categories of education and prevention, outreach, screening, referral, intervention and treatment, and service improvements through coalitions and teams. Each entry describes the model program and includes contact information as well as program evaluation findings. The highlighted programs included are: Healthy Aging Program, Salt Lake County, Utah; Health Enhancement Program, Seattle/King Counties, Washington; Little Havana Health Program, Miami/Dade County, Florida; Gatekeeper, Spokane, Washington; PATCH, Baltimore, Maryland; Geriatric Regional Assessment Team, Seattle/King Counties, Washington; Kit Clark Senior Services, Boston, Massachusetts; Over 60 Health Center, Berkeley, California; Elder Substance Abuse Outreach Program, Chicopee, Massachusetts; Center for Older Adults and Their Families, New York, New York; Older Adult Outreach and Education Service, Ann Arbor, Michigan; Adair Elder Care, Adair, Kentucky; Alcohol and Drug Services - Prevention for the Elderly, Fairfax County, Virginia; Elders Wrap-Around Team, Concord, New Hampshire; Mental Health and Aging Coalition, Indiana, Kentucky, Ohio. Appendices include information on other nominated best practices. (Note: This publication is accessible online at http://www.ncoa.org/Downloads/ACFB780.pdf.)

22. P5280-15
Osgood, N. & Manetta, A.
Physical and Sexual Abuse, Battering, and Substance Abuse: Three Clinical Cases of Older Women
Journal of Gerontological Social Work; Vol. 38 (3), 99-113; 2002.
Journal article (case study)
By focusing on three clinical case studies, this article explores substance abuse among older women who have been physically or sexually abused. The first client was a homeless, alcohol abusing 80-year-old woman with a history of childhood abuse and subsequent victimization as an adult; the second woman had a history of alcohol abuse and ongoing valium abuse, who eventually revealed a history of childhood sexual abuse; the third was a victim of domestic violence throughout her 60 year marriage, first asked about the abuse at age 68 by her physician. Each client demonstrated characteristics of post-traumatic stress disorder (PTSD) and the literature indicates that women often abuse substances in order to numb themselves to the trauma, past or present. Social workers and mental health professionals working with women with abuse histories must first help them to attend to basic survival needs and assist them in developing safety plans if the abusive situation is ongoing. Awareness of community resources for shelter, substance abuse treatment, support groups, etc., are essential. In these cases, treatment consisted of ongoing evaluation of the clients' status, education regarding the nature of abusive relationships and their effect on mental health and self-esteem, and reminiscence therapy, which allowed the women to process their experiences at their own pace.

23. P5707-4
Wiscott, R., Kopera-Frye, K. & Begovic, A.
Binge Drinking in Later Life: Comparing Young-Old and Old-Old Social Drinkers
Psychology of Addictive Behaviors; Vol. 16 (3), 252-255; 2002.
Journal article (research)
Due to age related changes, binge drinking can be especially dangerous for older individuals. This study analyzes differences in binge drinking between the young-old (aged 65-74) and the old-old (aged 75 and older). A convenience sample of 326 community-dwelling elders (young-old n=189 and old-old n=137) were asked to report on their average weekly alcohol consumption, experiences of binge drinking (defined as five or more drinks at one time), and drinking consequences (using the Drinking Problems Index). Participants were also asked to rate their health and to provide information on medical conditions and medication use, and to report upon the level of assistance they required in performing activities of daily living (ADLs). They were also assessed for depression by use of the Center for Epidemiologic Studies Depression Scale. Of the results, 57.7 percent of the young-old group typically consumed alcohol during a one-week period (ranging from 1-12 drinks) while 20.4 percent of the old-old group consumed 1-6 drinks on an average weekly basis. Young-old also reported a 20 percent rate of binge drinking, compared to 5 percent among the older participants. Among the younger group, correlates of binge drinking included higher weekly alcohol consumption, being male, having a higher income, being Caucasian, reporting more alcohol-related problems and more health problems. Among the older group, correlates of binge drinking included higher weekly consumption, more alcohol-related problems, and being in better physical health and mental health.

2001

24. P5715-6
Campbell Reay, A. & Browne, K.
Risk Factor Characteristics in Carers Who Physically Abuse or Neglect their Elderly Dependents
Aging & Mental Health; Vol. 5 (1), 56-61; 2001.
Journal article (research)
The purpose of this study was to analyze the differences in risk factors of people who physically abuse dependent elders and those who neglect them. Of the 19 participants referred for psychological counseling, nine had admitted to physical abuse and ten had admitted to neglect. All abusers lived with their victims and were reported to be in good health. Researchers were assessed (by interview and by the administration of five screening tools) for the presence of risk factors that had previously been identified in elder abuse literature, including a history of substance abuse, a history of mental illness, a history of childhood abuse, and caregiver stress and isolation. Of the results, seven of the nine physical abusers reported heavy alcohol consumption, compared to only one participant in the neglecting group. Six of the nine abusers had been abused by their fathers in childhood (none were current care recipients), as compared to only one in the neglecting group. Abusers were more likely to experience severe depression than the neglectors, while neglectors were prone to mild depression and higher levels of anxiety. (U.K.)

25. N4720-9
Lazow, R.
Alcohol and Other Drug Problems in Older Adults: Health and Human Service Professionals Need to Be Aware
Family Systems/Family Therapy: Applications for Clinical Practice; Vol. 21 (1), 79-96; 2001.
(Co-published simultaneously in The Journal of Prevention & Intervention in the Community)
Journal article (scholarship)
Hospital data indicates that patients aged 65 and older, more than any other patient age group, are likely to be diagnosed with alcohol related disorders. This comprehensive article examines patterns of alcoholism, the medical and psychological impact of substance abuse, and barriers to treatment among this population. Patterns of abuse and misuse of prescription drugs (as well as over the counter medications) that may lead to addiction and polypharmacological complications are also discussed. Screening tools, such as the CAGE, HEAT and MAST-G are highlighted. Therapeutic considerations and interventions specific to this age group are presented.

26. P5738-3
Office of Applied Studies for the Substance Abuse and Mental Health Services Administration (SAMHSA), U.S. Department of Health and Human Services (HSS)
Substance Abuse Among Older Adults
The NHSDA Report (National Household Survey on Drug Abuse); November 23, 2001.
Online report (research)
This article provides an overview of substance abuse among older adults in the U.S. Drawing upon data from the 2000 National Household Survey on Drug Abuse (NHSDA), it is estimated that over half a million adults, aged 55 and over, used illicit drugs, and that over five million experienced binge alcohol drinking. Illicit drug use and alcohol use were higher for Whites than either Hispanics or African Americans. Males were more likely than females to consume alcohol, and they were more likely to binge and drink heavily. The findings also suggest that illicit drug use is likely to increase among elders as the "baby boom" generation ages. (Note: This article is accessible online at http://oas.samhsa.gov/2k1/olderadults/olderadults.htm.)

27. N4639-12
Reifman, A. & Welte, J.
Depressive Symptoms in the Elderly: Differences by Adult Drinking History
Journal of Applied Gerontology; Vol. 20 (3), 322-337; September 2001.
Journal article (scholarship)
This article explores the relationship between patterns of adult alcohol consumption and depression in later life. The sample of 2325 residents of Erie County, New York was surveyed via telephone interview regarding patterns of alcohol use throughout adult life and current symptoms of depression. The sample was divided into the following categories: lifetime abstainers from alcohol; those who drank but experienced no alcohol-related symptoms; those who drank and experienced alcohol-related symptoms prior to age 60; those who drank and experienced alcohol-related symptoms after age 60; and those who drank and experienced alcohol-related symptoms before and after age 60. The researchers hypothesized that those with the more extensive history of alcohol-related problems would be more likely to experience depressive symptoms in later life, while those who abstained lifelong would be less likely to experience depression as elders. Drinkers who never experienced alcohol-related problems had the lowest depressive symptomotology, while those who experienced alcohol-related difficulties both before and after age 60 had the highest.

28. L4518-4
Scott, C.M. & Popovich, D.J.
Undiagnosed Alcoholism & Prescription Drug Misuse Among the Elderly - Special Consideration for Home Assessment
CARING Magazine; Vol. 20 (1), 20-23; January 2001.
Journal article (scholarship)
The American Medical Association estimates that 3 million seniors may abuse alcohol, and research indicates a pervasive use of anti-anxiety agents among the same age group, yet substance abuse is greatly under-diagnosed among the elderly. This article describes the problem of substance abuse among elderly in-home patients and the need for accurate assessment and appropriate referral. The article includes discussion regarding how the aging process affects the metabolism of benzodiazepines, and how the use or misuse of such medications and/or alcohol increases the risk for falls, cognitive impairment and decline in functioning.

2000

29. P5275-21
Choi, N. & Mayer, J.
Elder Abuse, Neglect, and Exploitation: Risk Factors and Prevention Strategies
Journal of Gerontological Social Work; Vol. 33 (2), 5-25; 2000.
Journal article (research)
In this study, data from county adult protective services were analyzed to identify risk factors of domestic elder mistreatment. In particular, researchers compared risk factors for abuse, neglect and exploitation by others to risk factors for self-neglect. The risk factors analyzed include elders' gender, age, living arrangement, health conditions, mental health status, cognitive deficits, social support system, and alcohol abuse. Among the findings, elders who abused substances were more likely to be self-neglecting; cognitive deficits, inability to manage finances and home ownership were risk factors for financial abuse, which was more often perpetrated by strangers; and elders with greater physical health problems were more vulnerable to abuse and neglect by others. Intervention strategies and case management issues are also discussed.

30. P5737-9
Rigler, S.
Alcoholism in the Elderly
American Family Physician; Vol. 61, 1710-1716; March 15 2000.
Journal article/online
Research suggests that approximately six percent of older adults are heavy users of alcohol, and that two-thirds of these individuals began drinking at an early age. This overview is presented to assist family physicians in detecting and addressing alcohol abuse in older patients. The impact of alcohol abuse upon individual organ systems is discussed, along with the interaction between alcohol consumption and medication use. Treatment options, including pharmacological management of alcohol withdrawal, and age-specific treatment programs are considered. (Note: This article is available online at http://www.aafp.org/afp/20000315/1710.html.)

31. P5522-74
Schonfeld, L., VandeWeerd, C. & Berko, L.
The Relationship Between Elder Mistreatment and Substance Abuse
Funded by the Department of Elder Affairs; published by the University of South Florida, Louis de la Parte Florida Mental Health Institute, Tampa, FL; September 2000.
Agency report
The purpose of this project, sponsored by the Florida Department of Elder Affairs (DOEA), was to explore the link between substance abuse and elder abuse and neglect. The first section of this report provides a review of the literature on substance abuse and elder abuse. The following section presents the results of a key informant survey of law enforcement agencies in selected Florida counties to identify what information is collected regarding substance abuse in cases involving elder abuse. In the final section, records from Florida's publicly funded agencies (such as the Florida Abuse Hotline Information System or FAHIS, mental health services, and aging services) were examined to determine how frequently depression, substance abuse, suicidal potential and related disorders were identified in elder abuse cases, in order to offer services and support. In general, information regarding the mental health and substance abuse issues of elder victims was poorly documented, and APS records indicate that relatively few clients use mental health services (7.6 percent) and even fewer use substance abuse services (0.3 percent). Recommendations of the study include the need for the DOEA to begin coding and tracking substance abuse issues on both the Client Information Registration and Tracking System (CIRTS) and the Comprehensive Assessment and Review for Long Term Care Services (CARES) in order to provide appropriate services and support to elders. Further, the DOEA should provide training in elder abuse identification to those professionals who may be likely to serve as sentinels (such as law enforcement, protective service workers, health care professionals, social workers, case managers, and in-home service providers), and to develop a substance abuse assessment protocol for elders being served. Also, data collected by the FAHIS should include information regarding mental health and substance abuse issues of service users. Researchers stress the need for documentation to reflect the scope of this problem in order for policy makers to develop the needed alcohol abuse and drug abuse services for older residents. (Note: This report, available as a loan item, must be obtained through the Louis de la Parte Florida Mental Health Institute. For more information, please contact 813/974-4471.)

32. P5705-5
Spencer, C. & Smith, J.
Substance Abuse: Making the Connection - An Interview with Charmaine Spencer and Jeff Smith
Nexus; Vol. 6 (1); April 2000.
Online article (scholarship)
In this interview, Charmaine Spencer, a research associate and adjunct professor at the Gerontology Research Centre in Vancouver, and Jeff Smith, a substance abuse specialist from the Older Adult Recovery Center in Ann Arbor, Michigan, describe the difficulties encountered when addressing substance abuse as it impacts upon older individuals. In particular, they present the "clashing paradigms" of both the addictions field and the protective services field. While substance abuse treatment specialists see many services offered by adult protective services (APS) as enabling, the professionals in the aging field view traditional treatment approaches as unrealistic for seniors. The harm reduction model of treatment intervention is presented as a viable alternative. (Note: This interview is accessible online at the NCPEA's Nexus Reading Room at: http://www.preventelderabuse.org/nexus/spencersmith.html.)

1999

33. K4233-11
Blondell, R.
Alcohol Abuse and Self-Neglect in the Elderly
Journal of Elder Abuse & Neglect; Vol. 11 (2), 55-75; 1999.
(Co-published simultaneously in Self-Neglect: Challenges for Helping Professionals; O'Brien, J., ed., The Haworth Press, Inc.; Binghamton, NY; 1999.)
Journal article (scholarship)
Alcoholism and its prevalence among the elderly is discussed and presented as a contributing factor to self-neglect. Awareness of this problem can help professionals identify and intervene in such cases. A table outlining the typical effects of chronic alcohol ingestion on body tissues and organs is included and describes the consequences of damage to the functionality or integrity of the body. Screening, treatment, and intervention strategies are presented and discussed in relation to relevant studies.

34. K4212-8
Brownell, P., Berman, J., and Salamone, A.
Mental Health and Criminal Justice Issues Among Perpetrators of Elder Abuse
Journal of Elder Abuse & Neglect; Vol. 11 (4), 81-94; 1999.
Journal article (research)
This article reports the findings of a survey by the New York City Department for the Aging (DFTA) of older victims of reported domestic abuse seeking assistance from the DFTA Elderly Crime Victims Resource Center. Results support recent research suggesting that perpetrator pathology or impairment (such as mental illness and/or substance abuse) appears a stronger predicator of elder abuse than victim characteristics. Impaired and unimpaired abusers are compared on the basis of age, employment, living arrangements, and history of involvement with the criminal justice system.

35. A150-6
Jeste, D., Alexopoulos, G., & Bartels, S. et al.
Consensus Statement on the Upcoming Crisis in Geriatric Mental Health - Research Agenda for the Next 2 Decades
Archives of General Psychiatry; Vol. 56 (9), 848-853; September 1999.
Journal article (scholarship)
A new analysis suggests the problem between elder abuse and an older person's mental health or substance abuse is going to worsen with the aging of the Baby Boom generation. A panel of mental health experts looked at the issues of elders' mental health in this article.

1998

36. P5709-00
Blow, F., for the Public Health Service, Substance Abuse and Mental Health Services Administration (SAMHSA), U.S. Department of Health and Human Services (HHS)
Substance Abuse Among Older Adults Treatment Improvement Protocol (TIP) Series 26
Public Health Service, Substance Abuse and Mental Health Services Administration (SAMHSA), U.S. Department of Health and Human Services (HHS)Rockville, MD; 1998.
Agency report
This Treatment Improvement Protocol (TIP) presents a literature review of the topic of substance abuse and gerontology. It also provides information on best practices for health care professionals in screening, intervention and referral. Among the topics discussed are abuse of alcohol, abuse and misuse of psychoactive drugs and over-the-counter products, and legal and ethical considerations. Appendices include a review of assessment tools available, including the AUDIT, the Index of Independence in Activities of Daily Living, the Instrumental Activities of Daily Living (IADL) Scale, Geriatric Depression Scale (GDS) Short Form, The Center for Epidemiologic Studies Depression Scale (CES-D), and the Health Screening Survey (HSS), Revised. (Note: This publication is accessible online at http://ncadi.samhsa.gov/govpubs/BKD250/default.aspx.)

1997

37. P5711-275
Gurnack, A., ed.
Older Adults' Misuse of Alcohol, Medicines, and Other Drugs - Research and Practice Issues
Springer Publishing Company; New York, NY; 1997
Book
This book presents an overview of substance abuse in later life. Topics covered include the difficulties associated with screening and diagnosis, medical complications related to drug and alcohol abuse among the elderly, early versus late onset, and treatment alternatives. Chapters are also dedicated to the subjects of alcoholism and dementia, misuse of prescription drugs, interactions between alcohol and medications, illicit drug use, and the misuse of substances among nursing home residents. (Note: This book is not available through CANE.)

1996

38. J4112-6
Goodrich, C.
Abuser Chemical Dependency: Key Barriers to Elder Abuse Intervention, from
Silent Suffering: Elder Abuse in America
Archstone Foundation, California; 1996.
Paper/book
This articles reviews findings from recent research to look at the role of chemical dependency as a barrier to effective elder abuse interventions. The impact of chemical dependency on addicts and their family members and its relationship to elder abuse are discussed. Implications and future directions for policy makers and APS agencies are also considered.

39.P5078-5
Hwalek, M., Neale, A., Goodrich, C. & Quinn, K.
The Association of Elder Abuse and Substance Abuse in the Illinois Elder Abuse System
The Gerontologist; Vol. 36 (5), 694-700; 1996.
Journal article (research)
This research, and extension of an earlier study examining the Illinois Elder Abuse System (see CANE file #J3967-10), examines the role of substance abuse in 552 substantiated cases identified through the Abuse, Neglect and Exploitation Tracking System (ANETS). Substance abuse was identified in 13 percent of the abusers, who were more likely to be male, non-caregiving children of the victims. In addition, victims of substance abusers were four times more likely to be substance abusers as well. Cases involving substance abuse were more likely to be viewed by social workers as higher risks for future mistreatment. A major implication is the need for APS professionals to be trained in the detection of substance abuse.

40. K4330-10
Lustbader, W.
Self-Neglect: A Practitioner's View
Aging Magazine; No. 367, 51-60; Spring 1996.
Journal article (scholarship)
This article discusses self-neglect as seen from a practitioner's perspective. A number of possible reasons for self-neglect are discussed along with interventions. Reasons for self-neglect include the loss of the will to live, the violations of medical restrictions and addiction to drugs and alcohol. (Note: This article is accessible online at: http://www.findarticles.com/p/articles/mi_m1000/is_n367/ai_18200033.)


1995

41. P5710-244
Graham, K. et al.
Addictions Treatment for Older Adults - Evaluation of an Innovative Client-Centered Approach
The Haworth Press, Inc.; Binghamton, NY; 1995.
This book reports upon an evaluation of the Community Older Persons Alcohol (COPA) program in Ontario, which was specifically designed to allow an older individual to determine his or her own treatment issues. Case studies are presented to provide an overview of the COPA treatment approach. The approach differs from traditional treatment in that it includes outreach, in-home counseling, and does not require the client to acknowledge a substance abuse problem. Through the use of a variety of outcome measures, it appears that approximately three-quarters of the clients in this program experienced some improvement, despite the finding that most clients did not abstain completely from substances. (Canada)
(Note: This book is not available through CANE.)

42. L4398-18
Longres, J.F.
Self-Neglect Among the Elderly
Journal of Elder Abuse & Neglect; Vol. 7 (1), 69-86; 1995.
Journal article (research)
This study examines the differences between cases of self-neglect and cases of maltreatment by others. These cases were collected by combining three years of data from the Wisconsin Elder Abuse Reporting System with in-depth interviews from elder abuse investigators. It was found that certain living arrangements were associated with the type of maltreatment. Also associated were mental illness, drug/alcohol problems and dementia. The impact of these findings on policy, programs and practice are also discussed.


1994

43. P5740-5
Anetzberger, G., Korbin, J. & Austin, C.
Alcoholism and Elder Abuse
Journal of Interpersonal Violence; Vol. 9 (2), 184-193; June 1994.
Journal article (research)
This article reports a comparison group study that explores the dynamic of alcohol abuse among perpetrators of elder abuse. Twenty-three perpetrators of physical abuse were interviewed and compared with 39 caregivers of elderly parents with no history of abuse. Participants were interviewed regarding their physical and mental health as well as their social environment, the age and health of their elderly parent, their perceptions of caregiver burden, family conflict, and life crisis. They were also asked about the type, amount and frequency of alcohol consumption, the circumstances surrounding their drinking, whether anyone had ever told them they had a drinking problem, or if they believed that they had a drinking problem. Among the results, nearly two-thirds of the abusers reported daily alcohol use, as compared to 27.3 percent of the nonabusers. Half of the abusers consumed three or more drinks when they drank, as compared to 8.3 percent of the nonabusers. Interview excerpts indicate that some alcohol consumption was associated with interactions with the elderly parent. Researchers point out the need to develop elder abuse interventions designed to address perpetrator characteristics such as substance abuse.

44. N4664-6
McInnes, E. & Powell, J.
Drug and Alcohol Referrals: Are Elderly Substance Abuse Diagnoses and Referrals Being Missed?
BMJ (British Medical Journal); Vol. 308, 444-446; February 1994.
Journal article (research)
In this study, the medical staff from three hospitals in New South Wales, Australia, were surveyed regarding their practices in assessing and diagnosing substance abuse in this population. Two-hundred sixty-three patients were classified by researchers as problem substance users. Only 57 percent of the alcohol abusers were identified by medical staff; 38 percent of those identified by researchers as engaging in harmful tobacco use were identified by medical staff; none of the 81 patients identified as hazardous benzodiazepine users and only 3 of seven harmful benzodiazepine users were identified by medical staff. Overall, medical staff diagnosed only a quarter of problem users and considered referring only 10 percent for substance abuse treatment.


1992

45. N4569-26
Pillemer, K. & Wolf, R.
Domestic Violence Against the Elderly: Who Depends on Whom? What Difference Does it Make?
This paper is part of a series of reports from the Evaluation of Four Model Elder Abuse Projects, funded by the Florence V. Burden Foundation and the Ittleson Foundation;
September 1992.
Paper
In this paper, the authors cite studies that refute the notion that elder abuse is typically the result of caregiver burden. Dependency or impairment on the part of the victim is not identified as a common factor among abuse victims, despite popular assumptions due to early research. Based on the growing awareness that abusers tend to be more dependent on their victims, the authors recommend the ongoing study of, and interventions geared towards, perpetrators. Research has recognized such perpetrator characteristics as a histories of violence, substance abuse, involvement with the criminal justice system, and/or psychiatric hospitalizations.


1991

46. I3678-9
Korbin, J., Anetzberger, G., Thomasson, R. et al.
Abused Elders Who Seek Legal Recourse Against Their Adult Offspring: Findings From An Exploratory Study
Journal of Elder Abuse and Neglect
Vol. 3 (3), 1-17; 1991.
This article reports on an exploratory study of elders who use the legal system in response to adult children who abuse. The abusive adult children were overwhelmingly male with a history of mental illness and/or substance abuse. The elder victim typically lived with the abuser and contributed to his welfare. The abused elders have a large network of social and organizational contacts and are utilizing legal services in response to the abuse.


1990

47. N4888-8
Greenberg, J., McKibben, M. & Raymond, J.
Dependent Adult Children and Elder Abuse
Journal of Elder Abuse & Neglect; Vol. 2 (1/2), 73-86; 1990.
In this study, 204 cases of substantiated elder abuse (Wisconsin, 1987-1988) were analyzed quantitatively and qualitatively to explore the characteristics of dependent adult children who abuse their elderly parents. Forty-four percent of the sons and 14 percent of the daughters were substance abusers, and 11 percent of the perpetrators were mentally ill. The author emphasizes that in the case of the substance abusive perpetrators, the abuse was often occurring within the context of an alcoholic family system.


Date Unknown

48. N4637-12
Spencer, C.
Alcohol and Elder Abuse Cases
Gerontology Research Centre, Simon Fraser University, Vancouver, BC
Online article
This web article reports general statistics regarding elder/substance abuse in Canada and provides an overview of the many ways in which alcohol abuse can increase the risk of elder abuse. Alcoholism on the part of both victim and perpetrator is explored. Case vignettes illustrate intergenerational issues that stem from long-term history of abuse, as well as the impact of substance abuse upon acceptance of social services and upon mental health. This article can be accessed at the following web address: http://www.agingincanada.ca/Seniors%20Alcohol/1e6.htm.