Older adults are at risk for misusing or abusing alcohol and/or drugs. Changes in the body require that those who have used alcohol previously make adjustments in their alcohol use to account for these differences. For those who are taking medication, the combination of alcohol and their regular medication can lead to unwanted negative side-effects. Education about the risks and careful monitoring is required to prevent serious health consequences, including death.

It is important to remember, your older loved one may not be using alcohol or drugs any differently than they have in the past. However, as their bodies change, their tolerance and ability to metabolize alcohol changes, thus requiring adjustments in how much or how often they can safely drink.

Warning Signs

The warning signs of alcohol or drug misuse or abuse are changes in normal functioning, behavior or moods. The list below are some things to watch for that were not present in your loved one previously.

Feeling anxious or nervous

Agitation or irritability

Problems focusing or concentrating

Falls, bruises or burns

Trouble with incontinence

Change in hygiene

Change in eating habits

Trouble making decisions

Mood changes

Loss of contact with family and/or friends

Change in interests

Dizziness

Unusual responses to medication

Thoughts of death or wanting to die

Depression or sadness

Some of the signs may indicate other problems, like depression. Alcohol use will make depression worse, as it is a central nervous system depressant. If you are concerned about depression and alcohol/drug misuse or abuse, you may need to act sooner rather than later. It is also important to point out that mixing alcohol and drugs for anxiety and sleep problems (including over the counter varieties) can be deadly. Mixing alcohol and some antidepressants may not be a serious, but the use of alcohol negates the effects of antidepressants because it depresses the nervous system.

How to Address Your Concerns

Talking with your older loved one about his/her use of alcohol and/or drugs may be difficult for some. Many people become defensive when asked about their alcohol or drug use, and often do not tell the truth. This is especially true for someone who has been approached by people about drinking in the past. Here are some guidelines to help you address these issues in a way that is more likely to be heard as concern for their well being, rather than a desire to control them.

1. Educate them about the facts. Most people don’t consider the need to adapt their intake of alcohol based on their age and changes in their body. Begin by offering them literature from a reputable source that addresses these needs and concerns.

2. Give them resources. The Geriatric Mental Health Foundation and others have self-assessments and other resources that may be helpful in understanding the changing needs of older adults.

3. Ask to accompany him/her to see his/her medical provider. Chances are, their medical provider does not know how much or how often your older loved one is using alcohol. You may have an opportunity to ask if any of the medications your loved one takes have dangerous interactions with alcohol. It is helpful to take all medications (including over the counter brands) in a bag to the appointment so the medical provider is aware of any prescriptions written by other providers.

4.  Talk to the pharmacist. If you have permission to discuss your loved one’s prescriptions with the pharmacist, do so. Tell the pharmacist about your concerns and ask for guidance with regard to interactions of medications and alcohol. If you do not have permission to discuss his/her case, get a list of all medications (including over the counter brands), dosage, etc. and any allergies or special needs. Talk to the pharmacist about mixing alcohol with these medications, without mentioning the name of your loved one.

5. Request a physical or mental health assessment. If your loved one has not had a recent physical or mental health assessment, request that s/he get a comprehensive exam. Attend this appointment, if possible. If not, contact the doctor’s office and express your concerns to the medical provider who will be seeing him/her. They usually cannot and will not talk to you about their patient without a written or verbal release of information. However, they may listen to your concerns and note them in the chart. Remember – the provider can only go on what information s/he gets from the patient and family. Your input can make all the difference.

Getting Help from the Professionals

If you are unable to get your loved one to cooperate with any of these suggestions, and you are seriously concerned about his/her safety, you may have to take more aggressive action. When there are safety concerns, professional assistance can be useful. It is usually a last resort to report someone to Adult Protective Services (APS), but it may be necessary if you are truly concerned about the safety of your loved one.

You can contact the APS office in your community anonymously to ask for guidance. If you simply want local resources or suggestions, explain your concerns in general terms without mentioning the name of your loved one. If you want APS to investigate, you will need to give them the name and address of your loved one. If they believe s/he is at imminent risk, they will make an unannounced home visit to determine what can be done to help. In some cases, they may monitor the case for a few months to ensure the resources they put in place are working and the person is safe.

Another possibility in extreme cases is an involuntary hospitalization for a psychiatric evaluation. Contact a local hospital that offers psychiatric services for more information. Many specialize in geriatric care and may have alternatives that can help.

As a final last resort, you may need to talk to an attorney about guardianship or a conservatorship. These are extreme measures that are reserved for only those who are considered incapable of managing their own lives. A mental competency exam may be necessary for this option.

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"Alcohol/Drug Abuse/Misuse." GMHF: Geriatric Mental Health Foundation. Web. 20 Mar. 2014.

"Alcohol Use and Older Adults." NIH Senior Health. Web. 20 Mar. 2014.