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Making a Difference: Recognizing the Risk of Alcohol and Benzodiazepine Use by Older Women

by Connie Caneen, Student Nurse
Carol Eliadi EdD, JD, APRN
Assistant Dean and Associate Professor, School of Nursing
Massachusetts College of Pharmacy and Health Sciences

      Many people in the United States, when thinking about substance abuse, tend to associate the issue with the younger generation. Most of us do not associate substance abuse with the elderly. Substance abuse in the elderly, specifically abuse of alcohol and benzodiazepines, is much higher than most people may think. According to a recent article published by CNN, of the 25.6 million women over the age of 59, seven percent abuse alcohol and eleven percent abuse psychoactive drugs such as benzodiazepines (CNN, 1998). These numbers suggest that a problem exists and that patient education and staff education/ awareness in this area are of high importance.

      There are many problems associated with elderly women abusing alcohol and benzodiazepines in terms of both effects and recognition of the problem. These include (1) the obvious physiological and psychological effects of combining both alcohol and benzodiazepines (2) the normal changes of aging that contribute to differences in the metabolism and absorption of medications in the elderly as opposed to younger people and (3) most importantly, how this problem is generally compounded by the lack of awareness by health care professionals to the incidence alcohol and drug abuse by elderly women in this society. Nurses are often the first people within the health care team to assess the patient during a medical appointment or as part of their admission to the emergency department or hospital floor. A clinical presentation of what may be presumed to be a routine or normal process of aging may actually be related to the unanticipated effects of substance use and/or abuse. As the population ages in the United States, the problem of alcohol and benzodiazepine abuse may increase dramatically. Between 2000 and 2005, the resident population aged 55 years and older has increased 13% to 67.1 million. This rate of growth is more than four times the rate for residents under the age of 55 (U.S. Census Bureau, 2007).

      Health care professionals often fail to ask questions about alcohol abuse unless a problem is evident, even though it is well known that alcohol can interact negatively with most medications and that the elderly are routinely prescribed medications for a variety of chronic and acute conditions. Health care professionals must be alert to the early signs of hazardous alcohol and drug use and abuse. Nurses should ask general questions about recreational alcohol use. If the person reports that they do consume alcohol, the nurse should move to more specific questions about the amount and frequency of alcohol use. Questions to ask may include: “When was your last drink? How much did you drink that time? Out of the last 30 days, about how many days would you say that you drank alcohol? Have you ever had a drinking problem?” (Jarvis, 2008). As the misuse of prescription medications such as benzodiazepines is also a problem with the elderly, questions regarding current medication usage is also of high importance. Patients should be queried as to the reason for taking each medication, the dose, any presenting side effects and if they understand that alcohol may enhance or have adverse effects if combined with medication (Jarvis, 2008). Health care professionals should also be aware of the tools that are available to assess for alcohol and prescription drug use and dependence/withdrawal such as the CAGE questionnaire and the CIWA scale which are described in detail at the end of this article.

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