The dilemma of alcohol use among the elderly: Then what?

April 7, 2015
Dave Gustafson, Director
Center for Health Enhancement Systems Studies and NIATx
University of Wisconsin-Madison

April marks NCADD’s 28th Annual Alcohol Awareness Month with a focus on preventing underage drinking and its harmful consequences. Alcohol use and misuse among young people is extremely dangerous, no doubt about it. But at the other end of the lifespan, alcohol use among the elderly presents another dilemma.

Let me tell you more about my view of this.

If you’ve visited a nursing home you’ve probably seen a resident in a wheelchair who just seems to be out of it. The likelihood is that the person is daydreaming about the past: maybe refereeing a flag football game in the old neighborhood or teaching a high school English class, or having a picnic beside a lake surrounded by family on a nice summer day.

It used to be common in nursing homes (and maybe it still is) to use a practice called “reality orientation.” With this process, for some reason, we thought it was important to take a person out of their reverie. So, a staff person would come up to that resident and say something like: “Dave, it’s important for you to understand that you are here at a nursing home in Madison, Wisconsin, and it is Friday, April 3, 2015.” 

In other words, “You are alone in a wheelchair in a nursing home staring at the wall across from you.”

It never made sense to me that we should retrieve people from pleasant memories or daydreams to take them back to a hard reality.

And that’s not too different from how I see the issue of alcohol use among the elderly. For some older adults, alcohol is a source of comfort. Some consider it one of life’s few remaining pleasures. Should they be deprived of that?

Don’t get me wrong—I’m not advocating to leave alcohol abuse untreated among people of any age group. Alcohol use has risks for the elderly, even if it’s not abuse. For the elderly, alcohol use is linked to hospital readmissions, poor decision-making, and falls that can lead to nursing home stays. So many elderly end their days in a nursing home after breaking a hip. And we know that alcohol use contributes to a myriad of other health problems.

(See related blog post: A Hidden Epidemic: Older Adults and Substance Abuse)

The results of a recent study reported in the article, “Winding Down and Boozing Up: The Complex Link Between Retirement and Alcohol Misuse” found that older adults are often unprepared for the changes that come with retirement and other later life events. These changes can contribute to depression, financial worry, and troubling questions about the meaning and purpose of their lives. For some elderly people, a daily drink or two or three is the only way out of a lonely, isolating situation. While a few drinks a day might not qualify as dependence, older adults have a harder time handling alcohol. They get drunk quicker on less alcohol.

So tackling the dilemma of alcohol use with the elderly means we have to be prepared to answer the question “Then what?” What do we do when removing alcohol makes an older person even more lonely or more depressed? If we’re going to confront alcohol use among the elderly, we have to look at issues like of the meaning of life, loneliness, and isolation.

A solution that we’ve been working on at the Center for Health Enhancement Systems Studies is called Elder Tree. It's part of our Active Aging Research Center,  funded under a Center of Excellence grant from the Agency for Healthcare Research and Quality.

(Click this link to watch a 4-minute video about Elder Tree.)

With Elder Tree, we’ve designed a computer system specifically to address the loneliness and isolation that many elders face. Elder Tree is a website just for older adults aged 65 and older, living in Wisconsin, who have access to a computer and the Internet. It makes it easy for older adults to stay in touch with family and friends, learn about local events and resources in their communities, and track their health and personal to-dos. The health tracker focuses on falls prevention, safe driving, medication management, care giving, and health and wellness. The site also has discussion forums that allow participants to support and encourage each other.

What we’re doing with Elder Tree is not specifically intended as a treatment or recovery intervention. Through tools that make it easy for two people to connect, communicate, and build relationships,  we’re looking at Elder Tree as offering an alternative to the isolation that so often leads to and accompanies alcohol use among older adults.

And that’s all good, but Elder Tree and other tools still don’t do enough to help elders find meaning in their lives. That's the next “Then what?” that needs to be answered.

David H. Gustafson, Ph.D., is Research Professor of Industrial and Systems Engineering at the University of Wisconsin-Madison and director of the Center for Health Enhancement Systems Studies, which includes NIATx. His interests in decision, change, and information theory come together in the design of systems and tools to help individuals and organizations make effective changes. Dr. Gustafson leads a research team that has developed A-CHESS, a smartphone-based health system for recovery support and relapse prevention.

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