Alcohol Use: Treating alcohol use in older adults

Brief interventions for older adults with unhealthy alcohol use

Use SBIR (Screening, Brief Intervention and Referral) with all older patients who experience problems related to their alcohol use (EENet, 2022). This ranges from patients who consume relatively small quantities of alcohol to those with a severe alcohol use disorder.

Brief interventions are one-on-one counselling sessions that may include:

• Motivation-for-change strategies (from Fundamentals of Addiction)
• Patient education
• Assessment and direct feedback
• Contracting and goal setting
• Behavioural modification techniques
• Written materials such as self-help manuals.

The intervention may involve a single meeting or a series of two to four meetings. It can be as simple as expressing concern about the amount of alcohol a patient is consuming and suggesting that the patient abstain or reduce their drinking.

The U.S. Center for Substance Abuse Treatment lists the following steps for brief interventions with older adults (1998):

1.  Customized feedback: Go over the patient's responses to screening questions about drinking patterns and other health habits such as smoking and nutrition.
2. Types of drinking: Discuss where the patient's drinking patterns fit into the population norms for their age group (e.g., "Thinking about Drinking")
3. Reasons for drinking: The “why” of alcohol use helps the practitioner understand the role of alcohol in the context of the older patient’s life. The reason(s) a patient drinks is particularly important, and may include coping with pain, loss and loneliness.
4. Consequences of heavier drinking: Some older patients may experience problems with physical, psychological or social functioning even though they are drinking below cut-off levels.
5. Reasons to cut down or quit drinking: A desire to maintain independence, physical health, financial security and mental capacity can be key motivators in this age group.
6. Sensible drinking limits and strategies for cutting down or quitting: Useful strategies with this age group include developing social opportunities that do not involve alcohol, getting reacquainted with hobbies and interests from earlier in life and pursuing volunteer activities.
7. Drinking agreement in the form of a prescription: Agreed-upon drinking limits that are signed by the patient and the practitioner are particularly effective in changing drinking patterns.
8. Coping with risky situations: Social isolation, boredom and negative family interactions can present special problems in this age group.
9. Summary of the session.

Considerations in treating harmful alcohol use in older adults

When treating older adults with harmful alcohol use patterns, consider:

• Counselling patients about Canada's Guidance on Alcohol and Health.
•  Medical withdrawal management for patients who meet criteria for alcohol dependence (inpatient withdrawal is recommended for people who are frail and elderly).
• Recommending pharmacotherapy
• Thiamine supplementation
• A consultation with an occupational therapist to determine whether in-home safety adaptations are needed to allow the patient to remain safely at home or whether the patient needs to be institutionalized.
• Reporting to the appropriate governmental ministry of transportation if you believe the patient has a condition that may make it dangerous to operate a motor vehicle.

Be aware of two other issues:

• The patient may have heard that moderate alcohol consumption can reduce cardiovascular and dementia risk, which may complicate the patient's acceptance of treatment recommendations for alcohol use disorders.
• Capacity to consent to or refuse treatment may be an issue with older adults. You may want to consult with a psychiatrist or geriatrician with expertise in this area if, for example, a patient refuses treatment and is incapable of safe, independent self-care.

Managing older patients who refuse treatment for their harmful alcohol use

Some older patients may not be ready to accept treatment for harmful alcohol use.

A harm reduction approach allows primary care providers to work with people to moderate their drinking or to develop a healthier lifestyle, without demanding that they become abstinent.

Use the following strategies to reduce the harms of drinking in older patients:

• Provide health education about the connection between specific health problems and alcohol use, and about the risks of falls and injury.
• Help the patient connect with appropriate medical help.
• Encourage the patient to eat something throughout the day when drinking.
• Recognize and address the patient's mental health needs (e.g., untreated depression or anxiety).
• Recognize and address the patient's pain management needs.
• Explore non-drug alternatives to manage pain (e.g., heating pads, relaxation therapies, massage, swimming, tai chi).

A harm reduction approach can help older patients who drink to become more stable, making it possible for them to address their alcohol use problem more definitively.

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Information for Patients and Families

Addiction 101: Self-Directed Course

Canadian Guidance on Alcohol and Health

Videos

Alcohol Trends in Patient Populations - Dr. Robin Room

Alcohol Risks (Mini-Med School presentation) - Marilyn Herie