ALCOHOLISM AND ELDERLY: PRACTICAL TREATMENT SUGGESTIONS
If the elderly have some symptoms of psychological problems or physical problems, including a problem with alcohol, provide the same treatment you would for someone younger. Too often, problems of the elderly are dismissed under the assumption that the elderly are just complainers, “senile,” unlikely to benefit, will die soon anyway, or are incapable of appreciating help.In making an evaluation of an older person, do a comprehensive assessment rather than just a symptom-oriented search. Pay attention to the social, financial, emotional, medical, cognitive, and self-care status. The latter is often overlooked. Is the person able to do the daily activities required for well-being, such as preparing meals, getting groceries, taking medications as prescribed?Recent literature suggests that signs of alcohol abuse in the elderly may be less obvious. For example, DWI is an unlikely occurrence if the elderly no longer drive. Instead of accepting self-neglect, confusion, or repeated falls as the vicissitudes of aging, they should prompt questions about alcohol use, just as they would in a younger person.Because many elderly persons are reluctant to seek or receive professional help, a family member is often the person to make the first contact. This will initially be your best source of information about the person. Be sure to find out the family’s views of the situation, their ideas, and fears. Whatever the problem, the chances are good that something can be done to improve the picture. Let the family know about this optimism. It often comes as a surprise to them that their elderly relative may get better.Sometimes the family will appear to you as unhelpful, unsympathetic, or uncaring. This may be infuriating and annoy you. Even if this happens, do not alienate the family. Whatever problems there may be with the family, it is possibly the only support system the client has.In dealing with the elderly, remind yourself that you are working with survivors. The fact that they have made it even this far means they have some strengths. These people have stuck their necks out in the past and taken risks. Find out how they have done it, and see if you can help them replicate that. Also, raise their expectations that indeed they can “make it” again, just as they have before.Use all the possible resources at your disposal. In many instances the elderly need to become reinvolved in the world around them. Meaningful contacts can come from a variety of people, not just from professional helpers. The janitor in the client’s apartment building, a neighbor, or a crossing guard at the street corner may all be potential allies. If the person was once active in a church group, civic organization, or other community group, but has lost contact, get in touch with the organization. There is often a member who will visit or be able to assist in other ways. Many communities have senior citizen centers. They offer a wide range of resources: everything from a social program, to Meals-on-Wheels, to counseling on Social Security and Medicare, to transportation. If there is a single agency to cultivate, this is the one.In your interviews with the elderly, the importance of reaching out, showing interest, and having physical contact has already been mentioned. Also be active. Do not merely sit there and grunt from time to time. Your quietness may too easily be interpreted by them as distance and dislike. Another very important thing to do is to provide cues to orient the elderly. Mention dates, day of the week, current events. For anyone who has had any cognitive slippage, good cues from the environment are very helpful. In conversation with the elderly, don’t stick with neutral topics like the weather all the time. Try to engage them in some topics of common interest to you both (such as gardening or baseball), as well as some controversial topic, something with some zip. This stimulates their egos, because it implies that you not only want their opinions, but you want them to listen to yours.If you give specific information to the client, also write it down for him in legible handwriting. This makes it much easier for the client to comply. If family members are present, tell them the directions, too. In thinking about compliance and what can be done to assist the elderly in participating in treatment, take some time to think about how your agency functions. What does it mean for an elderly client coming to see you? Are there long waits at several different offices on several different floors? Does it require navigating difficult stairs, elevators, and hallways in the process? Are there times of day that make the use of public transportation easier? Consider such factors, and make adjustments to make it much easier for your elderly clients. In specific terms, make every effort to do things in as uncomplicated, convenient, nonembarrassing, and economical a fashion as possible.Separate sympathy and empathy. Sympathy is feeling sorry for someone. The elderly don’t want that; it makes them feel like children. Empathy means you understand, or want to understand. This is what they would like.Be aware that you may be thought of and responded to as any number of important people in your client’s long life. Also, you may alternately represent grandchild, child, parent, peer, and authority figure to them at various points in treatment, even in the same interview, and at the same time.Display integrity with the elderly. Do not try to mislead them or he to them. They are too experienced with all the con games in life. If they ask you questions, give them straight answers. This, however, does not mean being brutal in the name of “honesty.” For example, in speaking with a client you might well say, “Many other people I talk with have concerns about death, do you?” The client responds, “No, I have pretty much come to terms with the idea of dying.” You don’t blurt out, “Well, you better think about it, you only have 6 months to live.” That is not integrity.In working with elderly clients, set specific goals. Make sure that the initial ones are easily attainable. This means they can have some surefire positive experiences. With that under their belts, they are more likely to take some risks and attempt other things.Make home visits. Home visits are the key to working with this group. It may be the only thing that will break down their resistance and help them get treatment. Very few will seek help on their own initiative. So, if someone is not willing to come to your office, give him a call. Ask if you can make an appointment to see him at home. If the response you get is, “I don’t want you to come,” don’t quit. Your next line is, “Well, if I’m ever in the area, I’d like to stop by.” And try to do that. Bring some small token gift, such as notepaper or flowers. After your visit, you may well find the resistance has disappeared.The home visit can be vital in making an adequate assessment. Seeing the person in his own home, where security is at its peak, provides a much better picture of how the person is getting along, as well as the plusses and minuses of the environment. It also allows the client to be spontaneous in emotions and behavior.If you regularly make home visits, beware of making the person “stay in trouble” in order to see you. Don’t just visit in a crisis. Instead, stop in to hear about successes. Your visits may be a real high point for the person, who may not like to think of losing this contact. Make a visit the day after the client’s first day on a new volunteer job, for example.Beware of arranging things for the elderly that will be seen as something trivial to occupy their time. If there is a crafts class, the point ought to be to teach them a skill, an art, not to keep them busy. Many of the elderly also have something they can teach others. The carpenter who is no longer steady enough to swing a hammer and drive a nail will be able to provide consultation to do-it-yourselfers who want to remodel their homes. The elderly have a richness of life experiences and much to contribute.Thoroughly evaluate symptoms of memory loss, disorientation, and behavioral changes to uncover potentially treatable causes of organic brain syndrome. Have clients show you all their medicines, including over-the-counter types. Coordinate medical care to avoid duplication of prescriptions.In closing, the task in working with the elderly is to assist them in rediscovering strengths, getting involved with people, and discovering life is worth living, at whatever age.*160\331\2*
