Summary

The article discusses the underrecognized issue of alcohol and substance use among older adults, its contribution to falls and hip fractures, and the importance of having difficult conversations about substance use with elderly family members.

Abstract

The piece emphasizes the significant impact of alcohol consumption on the risk of falls and hip fractures in the elderly, which can lead to a loss of independence and major lifestyle changes. It highlights the necessity of addressing substance use disorders (SUD) in older adults, who may be more prone to concealing their alcohol consumption due to stigma or may be overlooked by healthcare providers. The article suggests that while some older adults may be set in their ways, others are open to making healthier lifestyle changes, as exemplified by the author's personal experience. It also points out that signs of SUD can be mistaken for other health issues common in older age, such as depression or dementia. The article encourages family members to be vigilant for behavioral and mental changes that may indicate SUD, especially after significant life events, and to approach the subject with empathy and concern rather than labels or demands. Resources for understanding alcohol's effects on aging and strategies for prevention are provided.

Opinions

The author believes that it is crucial to talk about substance use with older family members, as it can have serious health implications and may often be a hidden contributing factor to accidents like hip fractures.
There is an opinion that healthcare providers may not always address alcohol consumption in older adults due to assumptions about patient honesty, time constraints, or lack of training in substance use issues.
The author suggests that the stigma and denial surrounding alcohol use in the elderly can lead to underreporting and a lack of proper screening, which needs to be addressed by medical professionals.
The article conveys the idea that while some older adults may be resistant to change, others can and do make significant lifestyle improvements, including altering their drinking habits.
The author expresses that family members should be proactive in discussing substance use with their elderly loved ones and involve healthcare providers when necessary, offering support and resources rather than judgment.

DIFFICULT DISCUSSIONS CAN SAVE LIVES

Is Alcohol or Old Age the Cause of Your Older Family Member’s Broken Hip?

Talk about substance use with loved ones before it’s too late

“Grandma, were you drunk when you fell and broke your hip?”

Most would feel uncomfortable asking this question. But the truth is, many older adults who suffer a broken hip do so while under the influence of alcohol or other substances.

This piece discusses the relationship between alcohol use, falls and hip fractures in older adults. It includes suggestions on how to broach the subject of substance use with family members and where to find helpful resources.

It’s hard to recover from a hip fracture. Afterward, many cannot live alone. This lack of independence enormously impacts the person and their loved ones.

As people age, the likelihood of hip fractures increases. According to the CDC, each year in the US, over 300,000 people aged 65 and older — are hospitalized for hip fractures. Over 95% of these injuries are caused by falling.

Alcohol and falls

In older adults, too much alcohol can cause balance problems and falls. Older adults have thinner bones than younger people, and their bones break more easily. Studies by the NIH show the rate of fractures in older adults rises as alcohol use increases.

We all know many older people drink and use other substances. Have you noticed that family and friends don’t often talk about this? Why are we not addressing this problem, and why don’t doctors routinely ask older adults about their drinking and substance use habits?

Assumptions about habits

One reason may be that we assume if a person has reached the grand old age of 65 plus, they are likely set in their ways and unwilling to change. While this may be true for some people, others are ready to learn how to improve their health and make changes accordingly.

My husband and I stopped drinking a few years ago, in our mid-fifties, and it was one of the best decisions we’ve ever made. At the same time, we improved our diet and started exercising more regularly. We’ve seen considerable improvements in our health, including sleep, mood and balance.

Stigma and Denial

Doctors may not ask older adults about their drinking habits because they assume they are low-risk. However, patients may not always be honest about their alcohol consumption due to stigma, shame, or denial. Doctors don’t know what goes on behind closed doors, so they must ask.

Generally, the older we get, the more health issues we have to deal with. Due to time constraints during appointments, doctors may prioritize addressing other age-related health concerns, such as chronic diseases, medications, and mobility issues. These may take precedence over alcohol-related discussions.

Lack of Training

Not all healthcare providers receive comprehensive training in addressing substance use and alcohol-related issues during medical school or residency. Some doctors may feel less confident or knowledgeable about discussing alcohol consumption with their patients. Doctors may also hesitate to broach the topic if they suspect the patient may react defensively or negatively. They don’t have time for arguments.

Some doctors may use standardized assessment tools to screen for alcohol use and dependence. If a patient doesn’t score high on such assessments, it may be because they haven’t answered honestly. In this case, the doctor may not see a need for further discussion.

Substance Use Disorder

How do we know if our older relative has Substance Use Disorder or SUD?

SUD is when a person uses substances even though they cause harm to themselves or others. It can range from mild to severe. Moderate to severe SUD is sometimes called dependence. People who have it find it hard to control their use.

This disorder can develop from using almost any substance, including alcohol, illegal drugs, prescription medicines, and over-the-counter medicines or mixing alcohol and drugs. Doing any of these can lead to serious health and financial issues and legal trouble. It is also likely to harm relationships with family and friends.

It’s easy to overlook SUD in older adults because:

They are more likely to drink or use substances at home rather than in public.
They may not have duties affected by substance use, such as going to school or work.
Signs of SUD are similar to symptoms of health problems many older adults have, including depression and dementia.
Caregivers may be aware of the problem but unwilling to discuss it with older adults.

Warning signs of SUD

Signs an older adult may have SUD may include changes in behaviour and mental abilities. Substance misuse often starts after a significant life event. Examples include retirement, the death of a loved one, moving home, and being diagnosed with a disease. When loved ones go through life-changing events, watch for signs of SUD.

A few days after my mum died, I went to the grocery store with my dad. He drove recklessly, careening around bends and exceeding speed limits. I feared for our lives. When we arrived at the store, he parked diagonally across the parking spot.

I’d never previously had concerns about my dad’s driving. I later realized that his grief over Mum’s death had led to some daytime drinking.

The following signs may not mean that a person has SUD. Some could indicate other health problems, including stress.

Changes in behaviour

Falling frequently
Not making it to the toilet in time (incontinence)
Having more headaches and dizziness than usual
Not looking after personal hygiene
Changes in appetite and food preferences
Isolating themselves and not keeping in touch with family and friends
Experiencing money or legal problems.

Changes in mental abilities

Feeling anxious a lot
Forgetfulness
Trouble focusing or making decisions
Losing interest in activities they usually enjoy
Mood swings, sadness and depression.

What we can do to help

It may be hard to broach the subject and get someone to discuss their substance use, but they will appreciate that you care enough to work past the discomfort of these conversations.

Focus on your concern about your loved one’s substance use. Explain that you’re worried about their health. Be empathic and understanding, and avoid using labels like “alcoholic” or “addict.” Offer options instead of demands.

If you notice signs of SUD in a loved one, talk to their doctor. Tell the doctor about the person’s substance use habits, including any misuse of prescription and over-the-counter medicines. Mention any substance use in the person’s past.

Encourage older family members to participate in exercise programs and get regular health checks, including eye tests. You can find more facts about alcohol and aging here and tips on preventing falls and hip fractures here. Visit the Rethinking Drinking website for information on signs of alcohol misuse and strategies for healthier living.

If you suspect a loved one is struggling with a substance use disorder, talk to them — before it’s too late.

Sources

HealthLinkBC — https://www.healthlinkbc.ca/health-topics/substance-use-disorders-older-adults
National Library of Medicine Association of Alcohol Intake and Fracture Risk in Elderly Varied by Affected Bones: A Nationwide Longitudinal Study
CDC — Hip Fractures Among Older Adults
NIH: Facts about alcohol and aging

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