Source: San Jose Mercury News Author: Brigid Schulte, Mercury News Washington Bureau Contact: Pubdate: Mon, 29 Dec 1997 ELDERLY AMERICANS BATTLE ALCOHOL Senior Drinking Too Often Ignored Hildegard Leonard, 73, used to wake to drink, and take her waking slow. A shot of scotch kept her numb and buzzing throughout the day, which she'd spend, usually in her pajamas, watching TV, dozing and waking only to drink more. Sober for eight years now, she was once one of America's darkest secrets: one of an estimated 3 million older alcoholics. As many as 20 percent of those over 65 have some problem with alcohol, several studies show. But since most of them spend dull, oppressive days alone and isolated, few people think there's a problem. But there is. More older people are hospitalized for alcohol than for heart problems. Nearly onefourth of all those hospitalized over age 60 are diagnosed with alcoholism, with treatment costs as high as $60 billion. One quarter of financially strapped Medicare's costs go to pay for substance abuse among the elderly. And alcohol is the drug of choice. With the much larger and much heavierdrinking baby boom generation 15 years from old age, the hidden problem will only get worse. ``By the year 2030, fully onethird of our population is going to be older adults,'' said Carol Egan, director of Older Adult Services at HanleyHazelden, a drug and alcohol treatment center in West Palm Beach, Fla., and herself a recovering alcoholic. ``If we don't start addressing older adult issues like alcoholism now, they'll be plunked right in our lap.'' Doctors often misdiagnose the shaking hands, confusion and memory loss of elderly alcoholics as old age. Many ask the wrong questions: ``How much do you drink?'' rather than, ``How does drink affect you?'' As the body ages, alcohol is not processed as quickly. One drink can do the harm in an older person that a sixpack used to. About 25 percent of patients diagnosed with dementia, many of whom are mistaken as Alzheimer's sufferers, are actually impaired by alcohol. Many In Denial Raised in the era of Prohibition, where drinkers were moral failures and alcoholics were bums in the gutter, most older alcoholics fiercely deny they have a problem. And many live reclusive lives, calling the liquor store for the next delivery, and are nearly impossible to reach. Spokane, Wash., is one of the few communities to try to bring older alcoholics into treatment. Under what is called the ``gatekeeper'' program, counselors train postal workers, meter readers and others who come in contact with the elderly to recognize problems with alcohol. Gatekeepers now find four out of every 10 admissions to local substance abuse programs. Families, many of whom live miles away, are often silent. Raised to respect their elders, they either leave them to their ``hobby,'' ignore the problem, don't want to air embarrassing dirty family laundry, or are unable to confront it. Those who do confront it find, usually after a lengthy search, that only a handful of treatment centers care for the elderly, that treatment costs can run into the tens of thousands of dollars and that Medicare has cut the inpatient treatment it covers from 28 days to five. The federal government, too, ignores the problem, focusing instead on youths. Research on the elderly gets 2 percent of the addictions budget; only one of the 14 federally funded addiction research centers is dedicated to studying the elderly. ``I feel I should have been ahead of this curve,'' said David Mactas, director of the federal Center for Substance Abuse and Treatment, who has set a March deadline for a report on how to better treat elderly alcoholics. ``It's not too late. But we've got to catch up.'' Older alcoholics have traditionally been divided into two groups: those who've had a problem all their lives, and those who begin to drink to excess only after retirement or the death of a spouse or out of depression. Larry Schonfeld, who works with older alcoholics at the Florida Mental Health Institute, said that because of the boredom and loneliness of old age, finding activities and social networks are keys to recovery. ``It's important to look for different ways to break the cycle of drinking in front of the TV and getting snockered,'' he said. Unlike many colleagues, Schonfeld does not believe alcoholism is a disease although many studies show it dramatically alters brain chemistry. Instead, he treats it as a problem that can be overcome. If people drink because they're angry, he tries to help them find a way to cope with anger. Few Seniors Treated But few people ever get into treatment. Researchers estimate only 10 percent of those with alcohol problems ever make it through a center's front door many coming in when families reach the breaking point during the heavy drinking and the emotional upheaval of the Christmas and New Year's holidays. Because alcohol is a chronic addictive problem, fully 80 percent of those who do get treatment will relapse, either once, or for good, within one year. In the face of such odds, Leonard's story and those of others like her offer hope. She was on the verge of joining the 30,000 older Americans who die every year from abusing drugs and alcohol. Instead, she changed her life. Leonard, who lives in Ann Arbor, Mich., had always been a social drinker, indulging at parties or sharing a drink with her husband at the end of the day. In 1975, when her mother suffered a stroke and had to be put in a nursing home, Leonard started reaching for a slug of scotch to brace herself before visiting. Then she found a swig once she got home gave her relief. Her husband's death in 1987 sent her into a twoyear alcoholic haze. She'd call her daughter, Suzanne Vanderburg, crying that no one cared about her or demanding that she come fix her a sandwich. Or she'd call her son, Richard, asking why she hadn't seen him in a few days. She lied about drinking. Constantly. ``I never hated her badly enough to disown her,'' her son said. ``But I came close.'' In And Out Of Programs Drinking a fifth of alcohol a day, Leonard dropped nearly 30 pounds. She was in and out of detox programs. Finally, Richard found the Older Adult Recovery Center at Chelsea Community Hospital, one of the handful of treatment centers aimed at the elderly. She went through the sixweek program once, then relapsed at her favorite restaurant, Sneaky Pete's. That did it for Richard. ``I just lost it. I said, `We've had enough.' She didn't care about anything, she was so selfish. I didn't want to talk to her anymore. I told her not to call anymore, and I hung up on her,'' Richard said. ``After that, she never drank again.''