A Fine Balance

Over the last few months Mrs. Smith’s family has noticed that she seems to have aged. Up until recently, their grandmother was active and socially involved. Now she is withdrawn, sleepy, and occasionally confused. They reason that it’s just the normal aging process.

After a visit from a health care worker, they discover that it is Mrs. Smith’s customary two brandies a day combined with her new pain medication and sleeping pill that are causing the problem. The family is shocked to discover that their grandmother has a substance abuse problem.

Substance Misuse

Social worker Susan Match of Richmond Addiction Services in Richmond, BC, doesn’t like to use the word addiction. She prefers the term substance misuse. Match deals with aging adults who have run into trouble balancing their alcohol intake. She helps her elderly clients sort out their medication and alcohol consumption by offering information and working with each person to identify ways they can make their lives healthier.

Match says that there is a common misconception that normal aging means a decline in mental function. Though physical and mental processes slow down with age, physical changes that occur as a normal part of aging allow elderly people to remain active, involved, fun, healthy, and alert. In fact, in the absence of disease, the effects of aging may not be felt until well into a person’s seventies.

On the other hand, there are signs not a result of normal aging that indicate an elderly person may be experiencing problems with drugs or alcohol. Match says such signs can include loss of appetite, confusion, anxiety, falling, sleepiness, sadness, irritability, unexplained chronic pain, and bruises.

Drugs and Alcohol–a Bad Combination

Adding alcohol into the medication mix can have serious consequences for the elderly. Because alcohol slows digestion, it can interfere with the absorption of medications. Another result of long-term alcohol use is liver damage, which impairs the body’s ability to process and eliminate medication.

As people age, they lose muscle mass and water content. This makes alcohol more concentrated in the blood stream; therefore, a previously established drinking pattern will result in a higher blood-alcohol concentration. Studies have also linked use of sedatives in the elderly to an increase in confusion, falls, and hip fractures.

Richmond Addiction Services recommends a limit of one alcoholic drink per day for anyone over the age of 65, or preferably none if the individual is on medication. They warn that one alcoholic beverage for a senior is equivalent to three for a young person.

The Goal: A Realistic Health Strategy

Match tells her clients, “It’s all about what you need to be healthier and happier.” Match emphasizes that it is up to each person to identify the things in his or her life that are not working and decide how to improve those things. She encourages seniors to make choices about what they want to change and how they want to go about making those changes.

Richmond Addiction Services offers assistance in the form of counselling, home support, nursing, and physical therapy. It enlists family and community members to support the seniors in their decisions.

Match also believes that a yearly review of several health factors is a useful exercise for everyone, not just the elderly.

Medications

Match asks her clients to review the medications they are taking and discuss with their health provider if these medications are still necessary. Since reducing intake of medications will lower the risk of side effects and drug interactions, seniors may want to visit their naturopathic doctor who can suggest nonpharmaceutical ways to enhance sleep, improve mood, and decrease pain. Of course, seniors must keep all their health advisors apprised of any new medications or herbal remedies prescribed by other health practitioners to avoid potential dangerous medicinal interactions.

Diet

A healthy diet can help seniors delay some of the physical decline associated with aging. Naturopath Alex Vasquez encourages his clients to eat a diet high in fruits, vegetables, nuts, and seeds with the added dietary support of a multivitamin/multimineral supplement. He also stresses the importance of vitamin D, available in milk, canned tuna, and pink salmon, and protein sources, such as soy and whey. The vitamin D in these foods not only helps strengthen bones, but it also acts as a natural antidepressant.

Since the Canada Food Guide now recommends a greater range of servings per food group, seniors might benefit from a visit to a professional nutritionist who can recommend appropriate quantities from each of the food groups.

Activity

Physical activity improves strength, balance, and endurance, thereby reducing the risk of falls. It is also an effective way to relieve depression and anxiety without medication. The Centers for Disease Control and Prevention (CDC) advise 30 minutes of moderate-intensity aerobic exercise such as walking, dancing, or rolling in a wheelchair, three to five days a week.

The CDC also recommends daily stretching and strength training two or three days a week. Seniors can get their strength workout at home by working in the yard, carrying groceries, or washing the car. Yoga and tai chi are great stretching activities that also build strength and balance.

Sleep

Many seniors believe a nightcap will help them sleep. While it may help initially, alcohol disturbs normal sleep cycles and can lead to rebound wakefulness during the night.

Match recommends trying alternate sleep-inducing methods–take a warm bath or drink a cup of herbal tea before bed. Teas with a mixture of lemon balm and camomile promote relaxation. Hops brewed as tea (or stuffed into one’s pillow) also provide a sedative effect that lasts through the night.

Back to Mrs. Smith

After reviewing her diet, activity, medication, and alcohol intake, Mrs. Smith decided that she was unwilling to give up her brandies altogether. Instead, she decided to eat a healthier diet and take a vitamin supplement. Also, by staggering her pain medication with her daily brandy, she would be able to remain alert and pain-free. Mrs. Smith also learned some healthy ways to promote sleep. The Smith family has their active and involved grandmother back.

Match’s nonjudgemental approach allowed Mrs. Smith to evaluate her life, learn about healthy alternatives, and make educated, personal choices. Match believes that ultimately,
everyone must take responsibility for what they put into their bodies.

Simple Ways to Support Your Elderly Family Member:

• Validate seniors’ independence by respecting their health decisions.
• Listen.
• Don’t be afraid to discuss sensitive issues such as nursing homes, death, and legal arrangements.
• Keep informed about community services that may be helpful to your aging family member.
• Remember it may be difficult for a parent to accept advice from their adult children. Get guidance from outside authorities.
• Have fun and maintain a sense of humour.
• Encourage those special relationships between grandparents and grandchildren.

Source: The Canadian Mental Health Association (cmha.ca).