Tackling Alcohol Dependency in Older Women

Alcohol dependency is often overlooked in older adults, especially women, whose symptoms often go undiagnosed by medical providers and caregivers. According to the Centers for Disease Control and Prevention, adults older than 65 binge drink more frequently than any other age group in the United States.

Nursing@USC Professor Dr. Benita Jeanne Walton-Moss — who has conducted research for her publication “Alcohol Use and the Older Woman” — says there is a profound need for health literacy surrounding alcohol dependency. “Women, like men, cope with problems in multiple ways, and alcohol is but one coping mechanism — a very important one that has huge potential negative impacts on a patient's health,” she says. 

The graphic below is a visual interpretation of the findings from her research. The information can be used to help nurse practitioners, caregivers and family members who are seeking guidance for addressing a patient or loved one’s alcohol consumption.

Read the text-only version of this graphic

Challenges to Identifying Alcohol Dependencies

According to Dr. Walton-Moss, addressing alcohol consumption comes with many challenges for older women. On the provider side, symptoms of alcohol dependency or misuse — fragility, difficulty balancing, memory loss, and unstable or unpredictable moods — can easily be misconstrued as typical signs of aging. Furthermore, the majority of alcohol prevention programs and organizations gear screening processes toward young adults. Older adults are often forgotten in these efforts, as people tend to believe they build up tolerance to alcohol with increased use. The facts remain that WHO’s recommended weekly maximum alcohol intake drops significantly from 10 to seven drinks when adults turn 65 and is limited to two drinks per occasion for women.

Mid-century American culture deemed drinking and smoking unladylike, up until both activities became symbols of feminist liberation during the 1960s and beyond. Beyond the scope of social drinking, the negative stigma that associates substance misuse with mental illness or instability makes it difficult for nurse practitioners and caregivers to ask about alcohol dependency in a respectful and sensitive manner. That does not mean, however, that it cannot be done.

Social Determinants at Play

Identifying the social determinants that make women more vulnerable to substance use can help providers and caregivers better understand the source of symptoms at play. According to Dr. Walton-Moss, older women may encounter some of the following hurdles:

  • Age: Older women often have smaller social circles, cope with grief and loss, experience loneliness, spend more time alone, and are less likely to be married than their male counterparts.
  • Education: “Older women may have less education than their male counterparts, and are therefore less likely to have comparable income or employment that yields access to health insurance,” says Dr. Walton-Moss.
  • Health Literacy: Adults over 65 have a harder time accessing health information that only exists online, or is not written in plain language. They’re also less likely to be included in medical decisions with their provider or caregiver.
  • Gender: “Women are likely to feel stigmatized when they have an alcohol dependency,” says Dr. Walton-Moss.

Screening Must Be Adapted for Older Women 

Because the symptoms of alcohol misuse are different for younger and older adults, it’s necessary to use a more specific screening method for older women. Dr. Walton-Moss suggests using an adjusted version of the World Health Organization’s AUDIT questionnaire, known as AUDIT-C, which consists of the first three questions in the list as is shown in the graphic above:

  • How often do you have a drink containing alcohol?
  • How many drinks containing alcohol do you have on a typical day when you are drinking?
  • How often do you have six or more drinks on one occasion?

The brevity of the survey, she says, makes it simple to evaluate whether the level of alcohol intake is healthy, because the questions are clear, easy to understand and quantifiable.

Interventions Require a Stigma-Free Approach

A brief intervention can help empower patients as well as their health care providers and caregivers. Of course, interventions come with their own stigma. Dr. Walton-Moss recommends that nurses follow the National Institute on Alcohol Abuse and Alcoholism’s guidelines for conducting an intervention with a patient when assessing her readiness to change her habits of alcohol consumption. While doing so, nurses and caregivers “have to recognize that having an alcohol problem is not equivalent to being a bad person,” she says. “Treating alcohol [dependency] as a biomedical problem, not unlike diabetes and hypertension” — rather than a character flaw — helps patients come to the same understanding.

Implications for FNPs and caregivers

The call for medical providers, caregivers and family members of older women requires sensitive, stigma-free screening to help patients and their care providers discuss alcohol consumption more openly. “We need to be educating both patients and caregivers that [alcohol dependency] is not an uncommon problem and does not equate alcoholism,” Dr. Walton-Moss says. “Recognizing early on that there is a potential problem increases the likelihood of addressing it in a timely basis,” and can curb the potential side effects before they take place, she says. 

If you or someone you know is at risk of alcohol dependency or misuse, visit www.niaaa.nih.gov for more information.