Assessing the individual nurse and his/her awareness of benzodiazepine and alcohol abuse in elderly women is an area that has not received much attention in the literature. Most of the literature that does exist focuses on the overall problem of substance abuse in the elderly and the signs and symptoms that may be present in elderly women as opposed to the assessment practices of the nurse when dealing with this actual or potential diagnosis. The literature is also weak in reporting how aware practicing nurses are of the substance abuse problem in the older adult and specifically in the older adult woman.

Review of the Literature

      The topic of alcohol and benzodiazepines abuse in the older woman is a topic that has received some research attention, but very little research has focused on nurse awareness in this area. Research reports that there are no age limits to substance abuse and that ages may range from as young as ten years to women in their seventies and eighties.  Susan Foster, director of policy research for the National Center on Addiction and Substance Abuse at Columbia University reports that because nurses are not looking for the problem of substance abuse in older women, it often goes unrecognized even when it stares right at them. The same finding has been reported for physicians as well. A study referenced in this same article reports that a two year survey of four hundred primary care physicians found that less than one percent of them considered a diagnosis of substance abuse in their older female patients even when typical signs and symptoms were described to them. Physicians were more likely to diagnose them with depression or anxiety and prescribe medications that could worsen any existing substance abuse problem. In older women, the most commonly abused substance is not alcohol but prescription drugs such as pain relievers or sedatives (National Women’s Health Report, 2006). In the 1990s the National Center on Addiction and Substance Abuse found that as many as 2.8 million mature women may be abusing sedatives which represent 44% of all women who have been prescribed these medications. Many of these women are also reported to be abusing alcohol as well (National Women’s Health Report, 2006).

      The consequences of prescription misuse and abuse of benzodiazepines among the elderly women are also reported in the literature. Older women are more susceptible to the cognitive impairments and overall sedation effects associated with most of these medications. These side effects are reported to increase the elderly woman’s risk for falls, other injuries, unintentional suicide and risk of dangerous interactions with alcohol (National Women’s Health Report, 2006). Dr. Simono-Wastila reported that older women often do not discuss the notion they may have a substance abuse problem because of the significant stigma attached to substance abuse and mental health issues. Providers also may not recognize signs and symptoms of prescription abuse in older women because they attribute them to such things as mental illness, dementia or to the side effects of medications they are taking for other health problems (National Women’s Health Report, 2006).

      Deborah Finfgeld-Connett (2004) reports that substance abuse in older women is predicted to become a more prevalent problem as the baby boomer generation ages and that benzodiazepines and alcohol appear to be the two most problematic drugs. As women age the same amount of alcohol that had little to no effect when they were younger can now cause the older woman to become inebriated. This is the result of many physiological factors such as reduced liver and kidney function which delays alcohol metabolism and elimination. As women age, lean body mass and total water content decreases while fat stores increase. Older women respond to benzodiazepines in the same ways as they do to alcohol in that lower amounts of the drug are required to achieve and effect and the effects last longer. If the use of benzodiazepines and alcohol is discontinued abruptly, withdrawal symptoms can develop even if the woman is taking the recommended dose of benzodiazepine medication. Alcohol and benzodiazepines are both depressants causing severe adverse effects when used in combination (Finfgeld-Connett, 2004).

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