Old-Fashioned Treatment for Addiction in Seniors
If your mother lived in South London, that’s exactly what could happen with the help of Tony Rao, PhD. He’s a psychiatrist whose specialty is addiction in seniors, and Monday through Friday he sees patients in their homes.
Making house calls isn’t any more the norm in the U.K. than it is the U.S. But years ago, Dr. Rao was assigned to a large, low-income area along the Thames River called Southwark Burough, where most of life revolved around working the docks.
A usual day in Southwark Burough began with drinking at 5 a.m. and ended with more drinking after work at pubs that were open 19 hours a day. After retiring from work, this generation kept up the culture of drinking. Rao realized that he needed more training to spot addiction, and 17 years ago he got it. “There’s a huge alcohol problem, and I couldn’t ignore it just because my patients are older.”
Through the U.K.’s public agencies, including government-provided healthcare, older patients are sent to Rao for what superficially looks like depression, or they’ve fallen and need follow-up medical care, or they’ve stopped paying their rent so the housing agency has referred them to Rao to establish their competency to care for themselves. Half of his patients are referred for treatment of sleep disturbance, anxiety or depression — all of which they might have.
But once visited at home, in the surroundings in which they feel most comfortable, Rao says conversation and patient questioning often reveal substance abuse. It’s there that he can also have all his other senses working to help fill in the missing information: Is the home musty and unkempt? Are there days’ worth of dirty dishes or rotten food in the kitchen? Are liquor bottles part of the décor? “I could see twice as many patients in an office setting, but I’d miss so much of the picture,” Rao says. “The approach has to take place where they live.”
Where these older people are, he says, is mainly in social housing in high-rise blocks, and his patients are 95 percent lower-income retirees living on meager government pensions. The area has a large number of pubs, but Rao says “many of my patients have alcohol delivered by taxi, and others go out early in the morning to avoid being seen buying alcohol.”
Earlier Diagnosis, Faster Treatment
Rao’s in-home psychiatric sessions can jump-start treatment because addiction is identified much earlier. A sign of how well he knows his patients can be seen in his own detailed description of those he may see over several weeks:
- A 69-year-old woman with post-traumatic stress disorder and binge drinking, living alone, and speaking limited English. She fled for political asylum after her husband and son were murdered in Chechnya
- A 70-year-old man with alcohol-related brain injury and schizophrenia living in a hostel in a state of self-neglect
- A 75-year-old man with depression, living alone, and recently bereaved, whose drinking started to interact with prescribed medication
- An 80-year-old man with alcohol-related dementia drinking a bottle of whiskey per day, sometimes with his wife and son
- An 82-year-old woman living in public housing and drinking a bottle of gin a day, having it delivered by a local taxi company from a 24-hour licensed liquor facility. She’s frequently intoxicated and has suffered a number of alcohol- related falls.
Addiction in Seniors: A Growing International Problem
Problem drinking and pill abuse among “the over 65s,” as they say in England, remains an obscure but looming problem in the U.K. and the U.S. Research has been limited. There are few specialists who know gerontology and addiction, according to a new book entitled Substance Use and Older People, co-edited by Rao, who’s also a visiting researcher at the Institute of Psychiatry, Psychology and Neuroscience at King’s College London.
Doctors aren’t taught about addiction in medical school. They typically have so little time with patients that screening for addiction amounts to a question on a form, such as “How many drinks do you have a day/week/month?” And as baby boomers enter their senior years, the new book reports, both countries will be overwhelmed with a lack of specialists to treat their higher rates of substance abuse of mainly alcohol and painkillers.
Alcohol is the substance that’s most abused by people over 65, the book says, followed by prescription medication, particularly opiates. A 2009 study found that among people 65 and older, 14 percent of men and 3 percent of women reported binge drinking at least once that year. Binge drinking, which is more common among older women in the U.K., is defined as having enough drinks in about two hours to raise the blood alcohol concentration to .08, which is typically 5 or more drinks for men and 4 or more for women.
Across the healthcare front, there’s a severe lack of adequately trained care providers for the “over 65s.” The Mental Health and Substance Use Workforce for Older Adults: In Whose Hands?, a book produced by a team of doctors and academics for the federal government, found that “at least 5.6 million to 8 million — nearly 1 in 5 — older adults in America have one or more mental health and substance use conditions, which present unique challenges for their care.” The same baby-boomer surge is looming in the U.K., Rao says.
Fighting Addiction, Armed With Pen and Paper
Rao travels by bus to see his patients, toting along nothing more than a notepad and something to write with — and his empathetic listening skills. Seniors deserve dignity and they’re quickly defensive toward judgment or patronization, he’s learned. They’ve lived a long time and they feel that deserves respect.
Sitting at their kitchen tables, he’s heard from nearly all of his patients that they want out of the isolation of addiction or old age. “They want to be able to do everyday things, to maintain the basic standard,” Rao says. So he frames the alcohol abuse with that in mind: If you’re depressed and drink, that makes you even less able to get back into your life.
Limiting access to alcohol is probably the number one thing a person can do if they feel they’re losing a loved one to booze, Rao says, but it may take indirection. Approaching a drinker with expressions of concern can trigger resistance: Drinkers have expressed to him that they feel picked on or judged.
“It’s much better to get them out of the house more, go with them to more social activities, and help improve their physical mobility by getting them away from alcohol sources,” Rao says. “It’s not easy, but it feels more positive and helps a drinker’s outlook to be moving around and out in the world.”
By Nancy Wride
Follow Nancy on Twitter at @NWride