Alcohol Abuse Advice

Emotional Problems in Later Life: Common issues in late life are retirement, divorce, widowhood, misues of prescription drugs, suicide, and neglect

Getting old is no fun, the 83 year old told her daughter. Having lost her husband suddenly, the result of an aneurysm nine years earlier and currently recovering from a complicated spinal surgery, she expressed the sentiment of many elderly adults. We have all watched as our parents, grandparents, neighbors, or friends navigate their way through the minefields of aging, hoping to avoid the disruptive effects of physical, mental, and social deterioration. Aging has emerged as an area of concern worldwide. Life expectancy has increased, largely due to advances in medical science, improved health care, and improved nutrition. As a result, the elderly population has rapidly increased, bringing a growing consciousness of this distinct group to society. The 60+ population increased 50.4% from 1960 to 1980 with projections of 57% from 1980 to 2000, and about 65% from 2000 to 2020. This 60-year span from 1960 to 2020 has a projected increase of 410% while there will be only a 157% increase for the total population.

1 The elderly are traditionally characterized in either a positive or a negative light. Some view the elderly as a source of wisdom, and they are respected, exerting influence in their families and in community life. Others see the elderly as dominated by major and irreversible losses, both physical and mental. Each view has demonstrable legitimacy. How individuals perceive old age is greatly influenced by how society as a whole views old age. The contrasting view of Asian cultures as opposed to our society is evidence of these two views.

 

The idea that aging can be stressful is a prevalent notion. The aging process can be fraught with an endless list of physical problems that result from both normal and abnormal physiological changes. Physical deterioration is inevitable. Mental deterioration and memory impairment, while frequent in later life, may not be inevitable. Physical and mental problems can be devastating for aging adults and their families. In addition, older adults are faced with changes that constitute significant losses. Numerous adjustments are required of aging adults as they encounter: retirement with its altered daily schedule and economic decline; marital disruptions related to divorce and widowhood; changes in living arrangements; experiences of trauma related to abuse and neglect; confrontations about the misuse of alcohol and prescription drugs; and an inability to deal with the inner turmoil that can lead to suicide. This is not a complete list of problems faced by elders, but it is an indication that there are obstacles in the path of aging adults that impact their remaining years. Christian mental health professionals have the opportunity and obligation to minister to this segment of society and bring a measure of comfort, healing, and blessing.

 

*Retirement*

Retirement, in most cases is a onetime event. Retirees reactions to retirement may vary from delight to dread but typically involve moving through stages, according to Atchey.2 These stages are not fixed and are not necessarily experienced in sequence or in total.

 

1. Pre-retirement stage anticipation of impending separation from employment.

2. Honeymoon stage a joyful phase of fulfilling old wishes and exploring new things.

3. Immediate retirement routine stage a phase for those who made advance plans and now can organize their lives into activity patterns.

4. Rest and relaxation stage a time of respite often followed by boredom and, for some, an attempt to reinstate some of the previous lifestyle.

5. Disenchantment stage in some cases, this stage can deteriorate into depression.

6. Reorientation stage a search for more realistic and appropriate life choices.

7. Routine stage selecting and committing to a new set of more satisfying patterns of activities.

 

8. Termination stage retiree either reenters the work force, becomes involved in new interests, or experience poor health and chronic impairments that preclude other choices. Retirement can be viewed as an achievement, an accomplishment. The retiree has completed a major phase of life and now can enjoy the fruits of the labor. For those who have developed interests and hobbies, this is a welcomed time of life. But for others, who have lived to work, this may be a time of difficult adjustment. For some, retirement represents more than just a cessation of work. It may represent relinquishing of power, control, and/or authority. The sense of accomplishment is lost as is the security of a daily routine. For those whose life was their work, there can be a loss of identity. Even in the best of circumstances, retirement requires some adjustment and problems may emerge. Marital problems develop when couples have difficulty adjusting to changes in their roles or to different lifestyles. Most couples have evolved into specific roles and division of labor.

Retirement may disrupt this structure. Isolation can result for those whose social life revolved around time spent with co-workers and who never developed a circle of friends outside the workplace. If retirement is accompanied by the decision to sell the marital home and relocate, the adjustment can be more difficult. Moving to another state, away from support systems in the neighborhood, the church, and the community, can result in times of loneliness and isolation. Older adults tend to find comfort and security in familiar surroundings. Financial concerns are a major issue when facing retirement. Most people have not been able to arrange their retirement income to maintain the same standard of living experienced

during the employed years. Incomes are usually fixed and are only a portion of the previous income. Social Security alone is well below poverty level. Adjusting to a reduced income can result in stress and worry about the financial stability of the future. Plans for a wonderful retirement may not be realized. Adjustment to retirement is not automatic. Retirement means change, whether welcomed or dreaded. Counselors can help the process along by being aware of the impact of this major life transition and can facilitate the adjustment by offering realistic suggestions for problem solving. For example, retirees have much to offer, and serving as a volunteer can enhance ones self-image and fulfill the need to be needed.

 

 

 

*Late Life Divorce and Widowhood*

Marriages are dissolved in two ways: by death or divorce. Either way, the loss is painful. Divorce is a time of crisis and one of life’s most stressful events. It is often compared to the death of ones spouse, especially with regard to the emotional impact and the need to reorganize ones life. Divorce in late life is especially difficult and profoundly affects the quality of life for the elderly. It tears apart a relationship that has existed for many years and forces both parties into new lifestyles that bring changes in every facet of everyday life. Although both men and women experience difficulties as a result of divorce, women are especially impacted. In her 10-year longitudinal study on divorce adjustment, Judith Wallerste in found that the economic, social, and emotional status of older women was distinctly different from that of the other subjects.3 Older women faced worse economic troubles as their incomes declined significantly. They experienced more widespread anxiety and loneliness, decreased involvement in interpersonal relationships, and none of the older women remarried.

The differences between older women and all other subjects was striking and sobering. This does not suggest that older men do not suffer economic, social, and emotional consequences. They experience the same difficulties that older women do; however, they tend to remarry at a much higher rate than older women do. As age increases, the opportunity for women Give away your life; you’ll find life given back, but not  merely given back given back with bonus and blessing. Luke 6:38

 

(The Message, E.H. Peterson translation)to remarry decreases greatly because they outnumber men. Currently, older women outnumber older men in every state in the United States except Alaska where the ratio is equal. Loss of a marriage impacts the quality of life and requires changes in ones lifestyle, but there are significant differences between divorce and widowhood. Those who have lost a spouse through death are afforded a parting ritual (funeral) and an extended period of time to grieve. The divorced are expected to get on with life. Sympathy and compassion are not equally distributed between the two situations. Death generously allows the widow the comfort of remembering the good times, while divorce tends to flood the memory with the bad times. The widowed have pictures to remind them of past joys with their spouses; the divorced often must still encounter the ex-spouse and re-experience the anger and pain. Economically, widowed and divorced older adults have a lower standard of living. And the older woman may be plunged to poverty level.

For the widow, there is often a downward adjustment on the pension and social security that results in income somewhat less than when the husband was alive. For the divorcee, access to the former husbands pension is usually denied, and the ex-wife has only her Social Security and any settlement awarded by the court. For women who have not participated in the workforce, Social Security is meager. Most older divorced women and many widows experience a severe decline in economic status. Socially and emotionally, divorced and widowed older adults must reorganize their support networks. The divorced may lose support from the ex-spouses family and from friends shared during the marriage. Widows are more likely to maintain some support from extended family and shared friends. The support that follows a divorce or the death of a spouse tends to diminish over time, leaving the older adult vulnerable to loneliness, isolation, anxiety, and depression. Connecting with others and developing new support networks facilitates the adjustment to the single lifestyle. At a time in their lives when they anticipated that life’s demands would

decrease, the widowed and divorced are faced with life’s most demanding transition.

 

 

*Suicide and the Elderly*

The suicide rate in most countries is higher for older adults than for any other age group. In the United States, suicide in the 65+ group is twice the rate of the rest of the population, with older males at highest risk. Although women attempt suicide three times more often than men, they are less successful than men, who typically choose more lethal means like firearms. Older adults commit approximately 20- 25% of all suicides.4 The risk factors for suicide among older adults are numerous. Depression is, of course, a major predictor for suicide and is generally correlated with significant changes in the aging adults life. The deterioration of physical health, cognitive dysfunction, stressful life events, substance abuse, relationship problems, bereavement, and genetic predisposition are contributors to later life depression. Suicide is most likely a response to the panorama of life’s circumstances rather than to a single factor or incident. Older adults commit suicide with

 

less warning than younger adults and are less likely to express suicidal intent. Previous attempts are significant predictors, but for men who tend to be very successful, this predictor may rarely appear. Treatment for the suicidal older adult may be difficult because the elderly (especially men) generally do not seek mental health services. Identification of suicidal older adults by others who have contact with the potential victims is essential. Because most elderly suicide victims have visited their primary care physician in the month prior to their suicide, recognition and treatment of depression in the medical setting is a promising way to prevent elderly suicide.5 Psychiatric hospitalization can provide an opportunity to involve suicidal older adults in therapy. A hospitalized patient who fit the high-risk profile was referred to me for therapy. He was an over-65 male who had lost his farm and his wife, had stopped going to church, had become a heavy drinker, and exhibited warning signs for potential suicide. Helping him reconnect with his previous spiritual foundation brought a fresh awareness of Gods love and opened the door for developing a treatment plan.

 

*Misuse of Alcohol and Prescription Drugs*

Alcohol and prescription drug misuse affect over 17% of the 60+ population. Substance abuse lowers the quality of life at any age, and it can have a devastating impact on the lives of older adults. Older adults consume alcohol for some of the same reasons younger adults use alcohol to numb psychological or physical pain. Several studies have indicated that about one third of alcoholism among the elderly began after entering later life. This suggests that a significant group  of older adults had alcohol problems prior to entering the last third of their lives. Late onset occurs more frequently with women; men more

commonly were drinking at an earlier age. Alcohol consumption tends to decrease over the life span; older adults drink less than their younger counterparts, but the drinking patterns are similar for all age groups.

 

The effects of alcohol on older adults differ from younger adults. Due to the aging process, tolerance for alcohol decreases with age. Health problems, social problems with family and friends, grief and loss, and mental problems exacerbate drinking patterns or are factors in late onset alcohol abuse. A significant danger exists when alcohol and prescription drugs are mixed. The ability of the aging liver to metabolize alcohol and medications is a concern. Accidental overdose can occur. Whereas older men are at greater risk for alcohol abuse, older women are at greater risk for the misuse of prescription drugs.

The National Center on Addiction and Substance Abuse reports that 2.8 million women over age 60 are addicted to psychoactive prescription drugs. Older women are more likely to visit family physicians and receive prescriptions, especially for psychoactive drugs. Although older adults make up about 15% of the general population, they consume 2535% of prescription drugs and a disproportionate amount of over-the-counter drugs.6 Misuse of prescription drugs can occur when the elderly patient does not understand the directions for the medication, forgets to take the medication, or accidentally or deliberately takes extra doses. The elderly experience numerous physical and emotional problems that require medications, such as chronic pain, insomnia, anxiety, depression, cardiovascular problems, and respiratory problems. Drug dependence and drug interactions are a major concern for the elderly.

The aging body typically has a decreased ability to clear the system of drugs, leaving the older adult at risk for overdose or serious side effects. The same medication that is a blessing can also be a curse. Treatment for alcohol problems and the misuse of medications varies according to theoretical orientation. The counselor s belief regarding the etiology of alcohol dependence (disease or dysfunction) will inform the choice of treatment. Engaging the older adult in treatment may be difficult and may require the assistance of family and friends. Unfortunately, most alcohol treatment programs are designed for younger populations and seldom address the unique problems of the elderly.

Treatment for the misuse of prescription drugs commonly begins with an intervention.7 Interested persons express their concern for the one who is abusing drugs, explain

how the problem has affected their relationships, and encourage the person to seek professional help. This method (also used with alcohol related problems) addresses the denial that is typically present. The prescribing physician is often unfairly blamed for the problem (Well, he’s the one who got this started by giving the prescription). In some cases, physicians do contribute to the problem and need to be included in the solution. Having a significant person go to the doctor with the older patient can be helpful for understanding directions for medications. Also keeping a list of all medications for the physician to review can aid in correlating the drugs. There are containers specifically designed for organizing medications by the week and indicating the day and time to take the medication. As is the case with alcohol abuse, there are few drug treatment facilities that accommodate the elderly. Hospitalization is an alternative; however, managed care generally does not pay for the treatment.

 

 

 

*Abuse and Neglect of the Elderly*

Elder abuse is generally divided into four broad categories (physical, psychological, financial, and neglect), and the definition of abuse usually depends on intent, severity, intensity, and frequency. Currently, only four prevalence studies have been cited in the literature and the results are considered an underestimate of the worldwide occurrence of abuse.8 One of these studies9 surveyed over 2000 non-institutionalized elders in the United States and found that: The prevalence of elder abuse ranged from 4% to 10% of those 65 years and older; abuse was perpetrated more often by spouses (58%) than adult children (24%); victims were equally divided between men and women; and neither economic status nor age were related to risk factors.

 

According to Wolf, the risk factors include: the abusers dependence on the victim (i.e., financial support); the psychological state of the abuser (i.e., mental health, substance abuse); the physical and cognitive state of the victim (i.e., frailty, memory deficiency); and family social isolation (i.e., housebound).10 Although empirical studies are lacking with regards to the consequences of abuse and neglect, Wolf reports that depression, learned helplessness, alienation, guilt, distrust, withdrawal, fear, shame, and post-traumatic stress disorder appear to be responses to abuse. Similar to the victims of domestic violence and child abuse, the elderly tend to hide or minimize the abuse, fearing abandonment and rejection. Interventions for elder victims of maltreatment vary according to the individual case, from crisis intervention strategies to treatment of longer duration. Of course, the primary goal is to end the abuse. Counselors need to explore the elders view of the abusive situation, keeping in mind the fear of abandonment and rejection experienced by most victims.

 

*Conclusion*

As Christians, we are instructed to minister to the hurting and wounded that we encounter in our society. As Christian counselors, we have no less of an obligation. The elderly are a segment of society that is often neglected and ignored by the professional world. As we become aware of the numerous problems the elderly face, we have the opportunity to bring help and healing. Christian Counselor is always available to help you out.

One of my students recently told me that I need to help her overcome her resistance to working with the elderly. She is aware of her responsibility to minister to her clients but has not developed a willingness to open her heart to aging adults. As I have talked and listened to others, I realize that there are many who share her view. This may be the result of living in a society that does not value the aged, or it may be an inability to face ones impending entrance into this dimension of life. There is an open field for harvest and an opportunity to minister to those in the final phase of life. Web counselor plays a vital role for the welfare of society.