Alcohol Rehab for Elderly

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Addiction affects all ages, including teens, adults, and the elderly. In most cases, senior alcohol rehabilitation programmes focus on those 55 years and older.

Treatment programmes for the elderly offer specific addiction treatment options. These include residential rehabilitation, outpatient treatment, intervention, and medical detoxification. Inpatient alcohol rehab centres for the elderly offer medical care that addresses any age-related healthcare issues.

They might also offer medications with low abuse risks to ease the symptoms of co-occurring disorders like mental or physical health problems. 

In the UK older adults have:  

  • The highest proportions of alcohol use, drinking over 14 units per week? (1) 
  • The highest rate of alcohol-specific deaths? (2) 
  • Have more people in alcohol-only rehab? (3) 

These findings underscore the need for a specialised rehab clinics for alcoholics programme for elderly people. 

Addiction Treatment Options for The Elderly 

The elderly are a vulnerable group and are at risk for substance abuse due to their physical, social, and psychological conditions.   

Studies show that addiction is steadily increasing in this age group. (4) Alcohol is the most common form of addiction partly because it is not illegal, is readily available, and is socially acceptable.   

The physical and mental decline in the ageing process requires a specialised addiction treatment for older people to meet age-triggered circumstances and specific needs, unlike those of the younger generation.  

As people mature in years, their bodies undergo many changes. The brain shrinks in size, lean body mass declines, bones become brittle and weak, and the capacity of lungs decreases.

The liver and kidney functions decline with age, and the danger of interaction between prescribed or illicit drugs with alcohol increases. (5)  

These physiological changes affect the absorption and metabolism of alcohol in the body, resulting in impaired cognitive skills and locomotor function.

Alcoholism causes falls, accidents, and motor vehicle crashes that lead to fractures, other serious conditions, and even death.   

Certain types of drugs are another common addiction in the elderly. Prescription drugs are misused for the beneficial effects they have on older people.

Most abused of these drugs are the benzodiazepines prescribed by doctors for anxiety and insomnia. Using benzodiazepines more than the recommended dosage results in depressed cognitive and motor function. (6) 

An overdose of these drugs may bring about depression, suicidal tendencies, and memory loss.   

Addiction treatment for the elderly should consider the individual's diminished bodily functions and check for existing mental health concerns and comorbid illnesses.

A World Health Organization study for 2019 reported that 60% of people in the UK who are 65 years and older have one or more comorbid conditions. (7) 

It is more difficult to detect an addiction problem in people who are 65 years old and over. The following circumstances contribute to this challenging situation for the elderly with an addiction:  

  • They may not be socially active due to retirement from work or disabilities.  
  • They may live alone and seldom see family members.  
  • Their drug abuse may be from prescribed medications, but their physical or psychological distress led them to take more than the prescribed dose. 
  • Symptoms of alcohol or drug abuse mimic signs of ageing to persuade and thus may be attributed to old age.  

Suppose an older adult has a substance abuse issue. In that case, intervention is advisable to convince them to seek treatment.   

An intervention is an act of calling the attention of an individual to their substance abuse. It is done in a non-confrontational manner to persuade the person to submit to rehab.   

Intervention can be performed by a family member or close friend who has the person's trust. A more formal intervention is done through a professional medical practitioner or a counsellor.

The older adult with drug or alcohol misuse is informed of their actions and behaviour resulting from substance abuse, the negative effects on their physical and mental health, and a plan for addiction treatment.  

Treatment Options for the Elderly to Choose From 

Seniors suffering from alcohol or drug abuse and seeking rehab can choose from two general types of treatment programmes: the age- or peer-specific rehab or abroad programme that anyone entering rehab can join, regardless of age or gender.   

While both types effectively treat substance abuse disorder, the elderly perform better in rehab when it is individualised.

Hence, a programme made up of a specific age group, especially for older people, has advantages that the general type lacks. (Oslin et al, 2002) (8)  

Why an age-specific rehab programme is better for the elderly with an addiction  

1. The medical specialists and staff are trained to handle elderly rehab. A high percentage of older adults who are drug or alcohol dependent have a co-existing mental illness or physical comorbidities.   

These are distinct disorders for their age group, such as dementia, Alzheimer's disease, and chronic illnesses, i.e. cardiovascular conditions, diabetes, arthritis.   

Depression and loneliness due to isolation are also common and may have contributed to alcohol abuse.  

2. In case of a medical emergency, such as when a senior is starting the detox, medical workers experienced and trained to handle emergencies in the elderly are present.   

Medical and neurological complications are more common in the detoxification of the elderly in rehab than in younger people.

These include myocardial ischemia, hypotension, aspiration pneumonia, delirium tremens, and hallucinations.

Medications may be administered to control the symptoms that arise from alcohol withdrawal in older people in rehab.  

3. In group sessions, connecting with other members is easier in age or peer-specific groups. Older adults can share life experiences, problems and challenges more readily when they are with people who can relate to the discussion.   

4. A seniors-only rehab programme is customised for age, health and psychological concerns, cause of substance abuse, and family dynamics. The resources used will address issues specific to the elderly to achieve complete recovery.  

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How Is Alcohol Use Disorder In The Elderly Treated 

A 2018-2019 report of Public Health England showed that people in treatment for alcohol-only dependency are most dominant in the 60 to 70+-year-old age group, with the number increasing as these people grow older. (9)  

The same report says that 80% of individuals aged 55 and over were starting alcohol-only treatment.  

Alcohol abuse in the elderly may be late-onset, occurring in the individual's senior years and brought about by major life changes.

These include removal from the workforce due to retirement, death of a partner, reduced social interaction, diminished financial resources and community roles, and decreased mobility.

These life changes that cause emotional problems such as depression, anxiety, inability to sleep, and loneliness often lead a person to drink.  

Early-onset alcohol misuse in the elderly started in the younger years and continued into old age or relapsed.   

Treatment of Alcohol Addiction in the Elderly  

Since seniors with alcohol use disorder are in frail health and may have emotional disturbances and physiological comorbidities, treatment for their addiction should consider these co-existing conditions. 

Detoxification  

Alcohol withdrawal syndrome in the elderly can have more serious complications than in the younger alcoholics. (10)  

Medical complications include myocardial ischemia, orthostatic hypotension, arrhythmias, and aspiration pneumonia.

Neurological complications are hallucinations, tremors, anxiety, disorientation, and convulsions.  

When these happen, short-acting benzodiazepines are administered to the patient. These are given for a limited period and gradually tapered to lower doses.

For example, lorazepam 30-60 mg every 4 hours by mouth or oxazepam 1-2 mg by injection are lowered to 50% on the 2nd and 3rd day. (11)  

Supplements of thiamine and folate, and multivitamins are also infused with intravenous fluids during detox when the elderly have withdrawal symptoms.

Glucose solutions are added for hydration, and the individual is monitored carefully for possible Wernicke's encephalopathy, a life-threatening condition that results from thiamine deficiency.  

Due to the higher risks that the elderly face in detoxification for alcohol dependence, the ideal setting for detox is in a hospital. 

Rehabilitation  

Rehabilitation of older adults with alcohol use disorder has a better outcome than in the younger ones because they adhere to the treatment methods and have better compliance with medications.  

Rehabilitation aims to help the individual achieve a full recovery and keep the motivation to stay sober high enough to prevent or reduce the risk of a relapse.  

Medication For Alcohol Use Disorder  

Seniors with alcohol addiction benefit from medications that support abstinence from drinking and prevention of relapse.

These medications are available only with a prescription from a medical doctor and should be taken under supervision. Monitoring of adverse reactions is required.    

1. Acamprosate 

Acamprosate (brand names: CampralRegtect) restores the chemical balance in the brain that has been altered by chronic abuse of alcohol.

When balance is regained, the craving for liquor diminishes and sobriety is achieved.   

Acamprosate is taken by mouth. In brands with 333mg of acamprosate in a tablet, the usual recommended dose is two tablets three times a day.   

Along with disulfiram, it is the main drug that the NHS recommends as a treatment for alcohol dependence. (12)  

2. Naltrexone  

Naltrexone (brand name: ReViaAdepend for tablet form; Vivitrol for injectable for) blocks the pleasurable feelings the individual feels when drinking alcohol.

Without the pleasant effects, the craving for alcohol is diminished.  

Naltrexone may be taken by mouth in tablet form at 50mg per day or 100-150mg every 2-3 days. It is recommended that the medicine be administered by a responsible family member or a doctor or nurse.   

The drug is also available in injectable form, which is given at 380mg every month. The injectable route is the preferred method because it maintains compliance and produces a more consistent blood level of naltrexone.   

Naltrexone is the suggested drug for the older adult alcoholic for preventing relapse and from a safety perspective.   

It should be taken only after the person has stopped drinking for at least four days. (13)  

3. Disulfiram  

Disulfiram (brand name: Antabuse) works by inhibiting the body's processing function of alcohol; hence, causing unpleasant reactions with alcohol. The purpose of prescribing disulfiram is to deter the drinking of alcohol.   

The drug is generally not given to elderly alcohol users over 60. (14)  

 It is also contraindicated in people with cardiac conditions, endocrine disorders, and impaired liver and kidney functions are present. These are common comorbidities in the older group with alcohol misuse.

Disulfiram is a tablet taken orally once a day. Its dose ranges from 250-500 mg as prescribed.

In combination with alcohol, it causes physical reactions, such as nausea or vomiting, flushing, severe headache, shortness of breath or rapid breathing, and irregular heartbeats. 

Alcohol Counselling  

An essential component of a comprehensive alcohol rehab programme includes the different types of counselling techniques that aim to change the individual's thinking and behaviour with alcohol addiction.  

Inpatient Alcohol Rehab for Seniors 

Inpatient alcohol rehab for seniors with alcohol use disorder have higher recovery outcomes from inpatient alcohol rehab, according to a cohort study in England). (15)  

Older adults are generally more vulnerable health-wise, and the risks from the detoxification stage of the rehab programme are seen as greater than that of the younger population.   

Inpatient rehab is done in a private rehab facility or detox centre. The elderly patient will get 24-hour support and monitoring from trained medical specialists and staff, where rehab usually lasts from 30 to 90 days. 

Why Seniors Need Inpatient Alcohol Rehab: 

  • They have a higher risk of having serious side effects from detoxification.  
  • They have comorbid conditions, thus requiring close monitoring during rehab.  
  • They suffer from loneliness, isolation, and depression and may have suicidal ideations.  
  • They may not have sufficient social support at home.  
  • They may miss rehab treatment as an outpatient due to limited mobility. 

Inpatient alcohol rehab generally consists of detoxification and rehabilitation through various methods of counselling.   

Alcohol detox is the process of clearing the body of alcohol. Detoxification is the first stage in alcohol rehab. The individual cannot proceed to further rehab without going through a detoxification.  

Withdrawal symptoms in alcohol detox may appear at about six hours after the last drink and peak 24 to 72 hours later.  

Minor withdrawal symptoms include nausea, rapid heartbeat, sweating, tremors, irritability and anxiety.   

Severe withdrawal symptoms may appear a week after the last drink and include seizures, elevated body temperature, hallucinations and delirium.  

It is recommended that the elderly alcoholic should never attempt detox at home or even in an outpatient setting because the symptoms may be life-threatening for this age group.

The inpatient rehab provides round the clock monitoring, and seniors with alcohol addiction will be under close supervision.  

Benzodiazepines are prescribed by doctors during the detox phase to control seizures. In older people, the dosage will be reduced.   

Rehabilitation after detox takes place through counselling in various forms and medications to reduce or eliminate cravings and to prevent a relapse. Counselling may be one on one or by a group.   

Individualised therapy between the therapist and the patient may cover a series of meetings and use different methodologies. The individual is assessed periodically.  

Group therapy usually consists of three to twelve participants and a counsellor who oversees and guides the discussion.

Sharing of experiences brings about different views and revising perspectives and behaviours that contributed to alcohol dependence. 

Addiction Treatment for Elderly 

In general, elderly alcohol dependence is a vulnerable group due to their age-specific physical and mental conditions.

Their addiction is also brought about by circumstances different from that of the younger group. Hence, alcohol rehab for them takes a special route to reach recovery and maintain sobriety. 

Inpatient alcohol rehab for seniors

Older people have a higher risk of developing permanent damage to brain cells due to prolonged alcohol use since age-related physiological changes in their brains make them less tolerant of the effects of alcohol. 

For instance, older adults are known to often lose grip of themselves, leading to a fall and break bones due to excessive alcohol use. They may also develop suicidal thoughts due to the loss of a loved one or loneliness.   Medical professionals at an inpatient alcohol rehab for seniors are trained to handle these specific issues in treating alcohol addiction in older adults.  [16] [17]

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About the author

Peter Szczepanski

Pete has been on the GPhC register for 29 years. He holds a Clinical Diploma in Advanced Clinical Practice and he is a Clinical Lead in Alcohol and Substance Misuse for Abbeycare Gloucester and works as the Clinical Lead in Alcohol and Substance Use in Worcestershire. To read more about Pete visit his LinkedIn profile.