Mr. R had been a successful photographer in New York City--married, with three children and a lovely apartment just north of Central Park. But decades of alcohol abuse eventually cost him dearly. Now 81, he lives on his own in a poorly kept studio apartment. Still battling alcohol dependency, he has no contact with his family, suffers from a number of chronic conditions, and was hospitalized 15 times last year.
"He is lonely and isolated, which exacerbates his alcohol use--and that, in turn, reinforces the isolation," says Kathleen Wolfe, LCSW, director of social work and behavioral health at my organization, VNSNY CHOICE Health Plans. What makes his story even more disturbing, she adds, is the fact that there are literally hundreds of thousands of Mr. R's living like this in the United States alone. "They're sitting home alone, drinking. They can't get out. They carry shame and guilt, and they think, 'What else is there?'"
Fortunately, for Mr. R, there is hope--and unconditional support--thanks to a team of nurses, social workers and peer support counselors working with him through his integrated care program, VNSNY CHOICE FIDA Complete. This plan, developed within the framework of New York State's Fully Integrated Duals Advantage, or FIDA, program, is available to individuals who are eligible for both Medicare and Medicaid, integrates the coverage of plans into a seamless group of offerings. Team members visit him regularly and are only a phone call away between visits.
"He is beginning to realize that his alcohol addiction is a disease and not a moral failing," says a social worker from VNSNY CHOICE FIDA Complete. Working with a local charity, the social worker got Mr. R a memory foam mattress to help with his chronic peripheral neuropathy. His home care team also makes sure he is able to get to doctor's appointments, and even persuaded him to attend an innovative geriatric substance abuse recovery program at Jewish Home Lifecare.
Although Mr. R relapsed six weeks after completing the program, Kathleen emphasizes that he is more willing now to talk about his alcohol use and to seek help on an ongoing basis. "Older people should know that relapse is not failure," she explains. "It is part of the recovery process, from which you learn trigger-awareness and develop coping skills. You wouldn't fault him if he was getting treated for hypertension and his blood pressure went back up, right?"
The New York State Office of Alcoholism and Substance Abuse Services (OASIS) calls alcohol abuse among the elderly "a hidden national epidemic." While some 10 percent of Americans are thought to abuse alcohol, among those aged 65 and over the number may be as high as 17 percent, says OASIS.
Older people who struggle with alcohol dependency face particular challenges. Alcohol is a depressant -- producing effects that, for older individuals facing isolation, limitations in mobility, and loss of friends or family, can deepen a downward spiral in health and well-being. Aging can also lower the body's tolerance for alcohol. And for those with chronic conditions or taking multiple medications, adding alcohol to the mix can be especially dangerous or deadly.
Recovery, which in the 12-step approach includes striving to make amends and turn one's life around, can also be complicated by aging. "What do you do when you're in your eighties and the people you need to make amends with are dead?" says Kathleen. In addition, "You have less life ahead of you than you have behind you--that's the reality of aging--and you can't turn that page as completely as when you're 30 and in recovery. At 30, you can still go to med school if you want to, which is probably not going to happen at 81."
What You Can Do to Help
While turning to alcohol may make be an understandable reaction to loss or isolation, alcohol dependency is unhealthy and is not a normal part of aging. Neither is it a moral failing or a reason to pass judgment. Alcohol abuse is an illness, and one for which there is treatment. If you suspect a friend, neighbor or family member is drinking too much, remember that isolation is one of the most potent contributing factors for alcohol use in elderly people. Do what you can to break that isolation, whether it's an afternoon visit, scheduling a regular morning walk together through the apartment hallways, or arranging a weekly trip to the grocery store.
During those outings, ask gentle questions about how your friend spends her days, and steer the conversation to treatment when you can. Begin with a trusted care provider, or find treatment services through the Substance Abuse and Mental Health Services Administration (SAMHSA). Most health insurance plans cover substance abuse treatment.
There are also ways to modify traditional recovery steps for an older person. For those seeking to make amends with a loved one who has passed away, he or she can write a detailed letter and read it aloud in a place that was significant to both parties. And while attending medical school may not be a practical life change for an octogenarian, engaging in smaller projects can make a difference, such as making a family scrapbook for grandchildren or going to a senior center on a regular basis.
What the Healthcare System Can Do, and Is Doing, to Help
People like Mr. R, with his 15 hospitalizations in a year, are called "super-utilizers," those whose complex chronic physical and behavioral health needs are not being well managed in the community. They frequent hospital emergency rooms and use a disproportionate share of health costs. Nationally, 1% of the population accounts for more than 22% of total healthcare spending, according to the Centers for Medicare & Medicaid Services (CMS), and the disproportion is even starker among Medicaid beneficiaries.
HMOs, including VNSNY CHOICE, reach out to those identified as super-utilizers to help them find less expensive, better integrated and more supportive care, to keep them out of the hospital and as healthy as possible in the community. "People like Mr. R actually jump out to us because of all those hospitalizations," notes Kathleen. "It's a public health cost. When you are a steward of public funds, you look for your high utilizers and try to treat them more effectively and at less cost. There's a human toll and a financial toll involved, and we can't afford to let it continue."
For Mr. R, that means a behavioral health specialist now visits each week to help him determine what tempts him to drink and help him avoid such triggers. A home health aide reminds him to be compliant with his medications and walks with him to Central Park. And, with the help of his care team, he is organizing a retrospective of his photographs of New Yorkers over five decades and talking to a community center about mounting the exhibit.
"We will stick with him," says Kathleen. "His story is everyone's story. As a society, we have to help all the Mr. Rs, for the fiscal health--and the emotional health--of our community."
For More Resources
The following agencies offer further guidelines on alcohol use and prevention among elders:
National Institute on Aging and SAMSA
Need help with substance abuse or mental health issues? In the U.S., call 800-662-HELP (4357) for the SAMHSA National Helpline.