If there is indeed a potentially addictive substance apprehended with complacency in our sometimes so puritanical country, it is alcohol. Even on the legal level, where wine enjoys a special status, the lightness of bacchanalian life outweighs the misdeeds of drink. Yet, although legal, alcohol is by far the most devastating drug. It is the third leading cause of morbidity worldwide, responsible for 49,000 deaths per year in France. One of these scourges is addiction, which tends to be underestimated because of this positive image — an image that powerful lobbies are working hard to achieve, more interested in maintaining the status quo and the profits industry than by the general interest. This is not to be moralizing — many users have a reasonable consumption, and excesses are also part of life — but simply to recall the damage caused by alcohol (and perhaps a certain hypocrisy public policies, in particular compared to illicit substances). It is said that to know if its consumption is problematic, a good test is the following:impose one day of abstinence per week, one week per month, and one month per year. Could you do it?
However, one segment that is often overlooked in debates around alcohol is that of the elderly. Minimized or even invisible, their consumption is rarely taken into account, which in turn leads to missed diagnoses. However, with the demographic increase of the elderly within the population, this question raises a real public health problem which is only set to grow! Here is a brief overview of the current situation.
To begin with, it should be noted that the proportion of non-consumers is higher among the elderly than among the rest of the population. 40% of them would therefore be completely abstinent after the age of 65 – a huge representation compared to the 10% of adults under 65 who are non-consumers. This is due to the increasing proportion of women with age, as well as the health problems that arise then and contraindicate the consumption of alcohol. This number is further artificially inflated by the early death of some abusive users.
Be that as it may, this proportion of non-consumers is the tree that hides the forest. Because if we often talk about the risk that hovers over young people, reputed lovers of binge-drinking, and likely under the guise of a so-called festive use to fall under the yoke of alcoholism, we generally pass over in silence the use older people. However, while acute consumption is indeed much rarer in this segment of the population, chronic consumption affects 19% of 65-74 year olds – mostly men. The other statistics, although rare and therefore imprecise in view of the lack of interest in this subject, abound in this direction:11% of patients over 65 would be in connection with alcohol; and in nursing homes, 20 to 40% of our seniors are alcohol-dependent!
There are two types of profiles in the elderly alcoholic. The first, which accounts for two-thirds of these people, is the long-term user, whose chronic consumption was established long ago and continued with age. On the other hand, a third of alcohol-dependent senior citizens would have started late, that is to say after the age of 60. This consumption is suspected to develop precisely in reaction to the hardships that accompany old age:the loss of loved ones or spouses, the idleness that retirement can bring, the presence of illness or infirmity - so many negative factors, which can of course also increase use among long-time users, who contribute to the isolation and marginalization, both physical and mental, of the elderly. Like any addiction, alcohol addiction is strongly favored by an unstimulating living environment, where substances appear as an alternative to an environment perceived as gloomy. In this case, problematic alcohol consumption is a response to traumatic events, and reflects a depressive character - a character that can be reinforced in a vicious circle by the consumption itself.
Such a peak in chronic alcohol consumption, and the arrival of new consumers at an advanced age, are indicative of the shipwreck that old age can represent for part of the population. This malaise reflects a certain failure in our social approach to aging. It is significant in this regard that alcohol consumption is ostensibly higher in institutions.
The heterogeneity of the elderly population makes any generalization difficult. Although the age of 65 is generally considered significant, there are an infinite number of different profiles, some presenting specific pathologies and/or a loss of autonomy, others not. Drinking has different origins as well as consequences depending on each individual's situation. Perhaps for this reason, problematic drinking can be difficult to detect, and its symptoms attributed to other causes.
Alcoholism among the elderly, in addition to being a somewhat taboo subject, is indeed often ignored both by the first concerned and by their relatives, and even by health professionals. One of the factors contributing to this is the basic marginality in which the elderly find themselves. Certain criteria such as the impact of consumption on professional life cannot therefore be taken into account, nor can the impact on driving for people who do not drive or no longer drive. Physiological and cognitive cues — tremors, memory impairment, propensity to fall — are sometimes simply attributed to advanced age. Likewise, tolerance, which normally increases with addiction, decreases with age, as fat mass increases at the expense of lean mass. So many factors that confuse the diagnosis, especially since the social isolation of some elderly people, coupled with a denial or a certain complacency vis-à-vis their consumption, does not help.
However, problematic alcohol consumption is extremely dangerous for older people. In addition to the many pathologies whose development is favored by alcohol (starting with cancers and cardiovascular disorders), one of the most important factors of death over the age of 65 are falls, which can of course occur more easily and prove fatal. in a drunken state. Older people are also more likely to be prescribed drugs, the interaction of which with alcohol can have explosive effects, or at least accentuate the effects of the drink.
The correlation between depression and alcoholism in the elderly is particularly significant. However, if it is not easy to determine which of the two occurs first, it is nevertheless important to detect problematic consumption, if only as a symptom of an underlying depression. Indeed, older drinkers are nine to ten times more likely to commit suicide than abstinent people. If the diagnosis is therefore made more difficult for the reasons mentioned above, it is nonetheless essential, and problematic consumption should not be minimized or taken lightly.
Like any addiction, alcohol addiction is difficult to treat. A reduction in consumption is desirable in all cases, but it should not be forgotten that this often reflects failures related to the environment. In the absence of a renewal of the living environment, an underlying depression will probably see little progress by simply stopping drinking, and may lead to a relapse. This is why prolonged follow-up is essential. In the same vein, group therapies have proven their effectiveness — at least for subjects who are compliant and inclined to quit.
Apart from extreme cases of addiction, which will go through a withdrawal period and which, due to their age-related fragility, require hospitalization, a collaborative approach with a health professional can therefore already produce results. The support of the entourage is essential, as well as the possibility of offering the patient an environment in which drinking and the incentives to drink are absent. Similarly, the will of the patient himself is paramount. It is therefore necessary first of all to overcome the denial that it may present. Whatever the case, these efforts are worth it, because even at an advanced age, stopping problematic consumption has short-term effects, in particular on the cognitive impact (memory lapses, etc.) which is usually reversible.
Finally, the big question is that of the prevention of alcoholism. But this is a matter of public policy, and the subject is currently absent — at least when it comes to the elderly. We must therefore raise awareness of this problem and train health professionals in more systematic screening, at least among people considered to be at risk (for example, a widowed man who smokes).
