Elderly women are thought to be at greater risk for abusing substances such as alcohol and benzodiazepines as opposed to their younger peers because of a related inability to cope with the many losses in their lives associated with normal aging, such as loss of a spouse, entering into retirement, financial stressors and/or the loss of the family home. According to Erikson, in order for older adults to age successfully they must be in a state of positive integrity vs. negative despair. Negative indicators can include an overwhelming sense of loss and an inability to cope which have been proven to increase the risk for abusing substances by older adults. Positive indicators of integrity include acceptance of the worth and uniqueness of one’s own life and feeling content and satisfied with choices that have been made (Berman, 2008).

       It is important for nurses to recognize the signs and symptoms of ineffective coping and to solicit specific information related to the use of alcohol and benzodiazepines by older adult women who are identified to be at risk. Many nurses may be uncomfortable or feel that it is inappropriate or disrespectful to ask questions related to the use of alcohol and benzodiazepines based on their own socialization toward the older adult, but in this case, it is an important and necessary component of the health history and nurses need to be able to overcome self-imposed barriers.

      Identification of the potential problem of substance use/abuse in the older adult woman is a crucial component of effective health care treatment. Many health care professionals are more willing to prescribe benzodiazepines to elderly women because statistically women, young or old, are not typically viewed as likely substance abusers. The vast majority of elderly women who abuse drugs and alcohol do not abuse illegal street drugs, but rather they abuse drugs that have been prescribed to them by their physicians.  Older women who abuse alcohol and benzodiazepines are also at higher risk of becoming more quickly addicted to these medications as compared to other cohorts of patients. A recent article in CNN reports that physicians may be exacerbating this problem when treating the older adult female patient. Many physicians will diagnosis elderly women with depression and prescribe treatment with anti-depressants or anxiety medications (benzodiazepines) when the real problem may actually be alcohol abuse that is masked. This then serves to further complicate the clinical situation for the alcohol abusing client as now the patient has the legally prescribed benzodiazepine to combine with alcohol that can lead to a lethal combination (CNN, 1998). Recent studies about the cost of alcoholism to society do not address the elderly specifically and this forgotten population is often times referred to as the, “hidden population.” In 1998, the NIH estimated that alcoholism costs 184.6 billion dollars in lost productivity, medical care, legal services and the cost of traffic accidents; however, this data does not address the cost or impact that results from the dependence on alcohol by the older adults in our society (Smith, 2006).

      Alcohol and benzodiazepine abuse in older women is significant to nursing because nurses are strategically situated within the healthcare delivery system to recognize the actual and potential risks of substance abuse in the older adult female patient and to provide appropriate interventions and education. In order to do this effectively, nurses must have the knowledge related to the risk issues and/or the signs and symptoms of the actual abuse of alcohol and benzodiazepines and make a concerted effort to incorporate questions related to the use of these substances into the health history. When elderly women present with complaints such as falls, decreased appetite, weight loss, irritability, chronic heartburn and other subtle signs and symptoms such as difficulty sleeping and/or psychological and somatic complaints, it is important for nurses to consider the possibility of substance abuse and to proceed with a focused health history and physical examination (Finfgeld- Connett, 2004). In considering substance abuse, many nurses may have a classic image of a substance abuser as an individual who is late for work, absent from important functions, having driving violations and/or having marital problems (Finfgeld- Connett, 2004). Because elderly women often have fewer obligations to society, family and friends may not witness these more typical events and as a result, may fail to recognize the need for help or intervention. It is important for nurses to have the knowledge necessary to at least consider the risk factors of substance abuse in older women and to have the comfort level to ask often awkward and uncomfortable questions related to the use of alcohol and benzodiazepines.

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