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Alcoholism among the elderly: Fact or fallacy

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Alcoholism among the elderly: Fact or fallacy

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Content INFORMATION TO USERS This manuscript has been reproduced from the microfilm master. UMI films the text directly from the original or copy submitted. Thus, some thesis and dissertation copies are in typewriter face, while others may be from any type of computer printer. The quality of this reproduction is dependent upon the quality of the copy submitted. Broken or indistinct print, colored or poor quality illustrations and photographs, print bleedthrough, substandard margins, and improper alignment can adversely affect reproduction. In the unlikely event that the author did not send UMI a complete manuscript and there are missing pages, these will be noted. Also, if unauthorized copyright material had to be removed, a note will indicate the deletion. Oversize materials (e.g., maps, drawings, charts) are reproduced by sectioning the original, beginning at the upper left-hand comer and continuing from left to right in equal sections with small overlaps. Photographs included in the original manuscript have been reproduced xerographically in this copy. Higher quality 6” x 9” black and white photographic prints are available for any photographs or illustrations appearing in this copy for an additional charge. Contact UMI directly to order. Bell & Howell Information and Learning 300 North Zeeb Road, Ann Arbor, Ml 48106-1346 USA 800-521-0600 Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. ALCOHOLISM AMONG THE ELDERLY: FACT OR FALLACY By URSULA RUST SWICEGOOD A Thesis Presented to the FACULTY OF THE LEONARD DAVIS SCHOOL OF GERONTOLOGY UNIVERSITY OF SOUTHERN CALIFORNIA In Partial Fulfillment of the Requirements for the Degree MASTER OF SCIENCE IN GERONTOLOGY August 1999 Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. UMI Number: 1397645 UMI UMI Microform 1397645 Copyright 2000 by Bell & Howell Information and Learning Company. All rights reserved. This microform edition is protected against unauthorized copying under Title 17, United States Code. Bell & Howell Information and Learning Company 300 North Zeeb Road P.O. Box 1346 Ann Arbor, Ml 48106-1346 Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. UNIVERSITY OF SOUTHERN CALIFORNIA LEONARD DAVIS SCHOOL OF GERONTOLOGY University Park Los Angeles, CA 90089 This thesis, written by tj U I A ^ s T -S ' ),<// ,'v f CtCbD _ _ _ _ under the director of hfc ^T hesis Committee and approved by ail its members, has been presented to and accepted by the Dean o f the Leonard Davis School of Gerontology in partial fulfillment of the requirements for the degree of:__________________________________________________________________ Dean THESIS COMMITTEE Chairman Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. ACKNOWLEDGMENTS My special thanks go to Dr. David Peterson for his patience and true love of teaching, and for his enthusiasm upon seeing something come to actual fruition. Thanks also to Dr. Gerald Larue who supported my topic and offered to introduce me to people in the field. It was through Dr. Larue that I came to meet Jim Christopher and many of the great members I spent time with from the organization which he founded— Secular Organization for Society (SOS). I am very appreciative to Marcia Freedman, Vice President of Public Relations and Public Information at the American Society on Aging (ASA). She was gracious enough to provide the list of 200 people from which I was able to compile my participant list. I also wish to thank those friends who gave me much moral support and technological know-how. They are: Mark Kevin Swicegood Ray Lanthier John Oliva ii Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. TABLE OF CONTENTS CHAPTER Page 1. INTRODUCTION....................................................................................... 1 Background............................................................................ 2 Statement of the Problem........................................................................4 Significance of the Problem.....................................................................4 Purpose of the Study................................................................................ 5 Research Questions................................................................................. 5 Methodology............................................................................................... 5 Delimitations............................................................................................... 6 Definitions of Term s.................................................................................. 6 Organization of the Remainder of the Study........................................ 7 2. REVIEW OF THE LITERATURE........................................................... 8 Definition of Elderly Alcoholism...............................................................8 Physiological and Psychological Impairments......................................9 Attitudes Toward the Elderly Alcoholic................................................ 10 Prevalence.................................................................................................11 Early-Onset Versus Late-Onset............................................................13 Treatment...................................................................................................16 The Role of the Helping Professional.................................................. 18 3. METHODOLOGY.....................................................................................23 Participants............................................................................................... 23 Procedure................................................................................................. 24 Instrumentation........................................................................................ 25 Data Analysis............................................................................................26 Limitations................................................................................................. 26 Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. CHAPTER Page 4. RESULTS...................................................................................................27 Demographic Data................................................................................... 28 Perceived Prevalence of Alcoholism Among the Elderly.................. 36 Alcohol Education.................................................................................... 37 Attitudes Regarding Alcohol Education............................................... 38 Referrals to Self-Help Groups............................................................... 39 Summary.................................................................................................... 40 5. DISCUSSION, CONCLUSIONS, AND RECOMMENDATIONS.... 42 Discussion..................................................................................................43 Conclusions.............................................................................................. 45 Recommendations for Further Research............................................45 Recommendations for the Field of Gerontology.................................46 SELECTED REFERENCES.............................................................................. 49 APPENDIX A: COVER LETTER AND QUESTIONNAIRE.......................... 51 iv Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. LIST OF TABLES Page 1 . Demographic Data— Sex and Ethnicity...............................................29 2 . Demographic Data— Education............................................................ 30 3. Demographic Data— Employment........................................................31 4 . Demographic Data— Current Job......................................................... 32 5. Demographic Data— Role in Current Job........................................... 33 6. Demographic Data— Organizations Worked......................................34 7. Demographic Data— Time Spent Working With Elderly.................. 35 Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. CHAPTER 1 INTRODUCTION An elderly woman living alone in San Francisco never answers the doorbell when it rings. Instead, she peers through the dark curtains. She is reclusive and has little to do with anyone, except for a small succession of women who have been sent to her house as home-care workers to do her light cleaning, marketing, and cooking. The woman is usually in the same tired bathrobe. Her eyes are watery; her nose and face are flushed. One by one she dismisses the workers, usually soon after they have discovered that she is a port wine addict. She would never consider having either a glass of beer, nor a drink of hard liquor. It would be presumptuous to state that she feels that she is medicating herself. When she finally has to be admitted to an acute-care facility for malnutrition, she is irate that her so-called caregivers have caused her to end up in this condition. Unfortunately, the case described above is common in the United States today. This woman is an elderly alcoholic. The fact that she has no family living with her means that she can drink in secret until, as in this 1 Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. case, she becomes ill and finally has to see a physician. Even then, the physician may not detect the alcoholism, which is what underlies her acute illness. This chapter provides an overview of a study of alcohol abuse in later life. The chapter begins with the relevant background information. This is followed by the statement of the problem, significance of the problem, purpose of the study, research questions, methodology, delimitations, and definition of terms. Background The Council on Scientific Affairs of the U.S. Department of Health Services (1996) noted that longitudinal research has shown that heavy drinking among the elderly is difficult to detect and takes its toll in physiological and psychological impairments. Mellor, Garcia, Kenny, Lazerus, Conway, Rivers, Viswanathan, and Zimmerman (1996) discuss the factors that make it difficult to determine that an elderly person is an alcoholic. These factors include their social isolation, the desire of family, friends, and even professionals to protect the elderly individual from being labeled as an alcoholic, and a lack of understanding of the seriousness of the problem. The Council on Scientific Affairs of the U.S. Department of Health Services (1996) stated that attitudes toward alcoholism among the elderly, 2 Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. even by the elderly themselves, the family, and physicians “can be formidable obstacles to identification, diagnosis, and treatment” (pp. 798- 799). They noted that physicians may be reluctant to accept responsibility for the elderly alcoholic and that, even when they do, they do not know how to address alcohol problems in the elderly. Hooyman and Kiyak (1993) add that due to the stigma attached to alcoholism among the elderly, it is difficult to obtain accurate statistics in regard to prevalence. Schuckit (1988) noted that rates of alcohol abuse among the elderly are not precisely known, in part because the diagnostic criteria for alcoholism have been established for a younger population. Further, because of the age of these individuals, they are less likely to be working and thus to lose a job due to alcohol. Also, they are more likely to be living alone, making it less likely that someone will witness their alcoholism. Finally, family members may be reluctant to bring the elderly individual in for treatment due to the shame of having an alcoholic family member. Despite these obstacles to determining prevalence, Schuckit states that the general consensus is that between 1% and 3% of women and 5% and 12% of men over 60 years of age have problems with alcohol. The Council on Scientific Affairs of the U.S. Department of Health Services (The Council) (1996) notes that physiological problems seen in elderly alcoholics include cirrhosis of the liver; cancers of the mouth, larynx, and esophagus; elevated systolic blood pressure; fractures; interactions 3 Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. with prescription medications; seizures and falls; and cognitive deterioration. The Council (1996) also points out the psychological effects are just as significant and that alcoholism and depression have been implicated in suicides and suicide attempts by the elderly. Statement of the Problem As noted above, alcoholism among the elderly is difficult to detect and diagnose. Part of this difficulty stems from the views and attitudes of health care professionals toward treating elderly alcoholic patients. As such, there is a need to determine current views and attitudes, particularly in regard to prevalence and treatment. Significance of the Problem The significance of the problem stems from two sources. First, in terms of diagnosis, the emphasis that the DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, fourth edition) places on problems related to drinking as the criterion for alcoholism are poorly applicable to the elderly, who are no longer working and tend to be socially isolated. Thus, alcoholism among the elderly may go undetected. Second, even when elderly alcoholism is detected by health care professionals, their attitudes toward working with and treating the elderly alcoholic may impair their ability to work effectively with such patients. 4 Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. Purpose of the Study The purpose of the study was to determine their views and attitudes, particularly in regard to prevalence and treatment, among professionals in gerontology. An additional purpose was to determine the attitudes of such professionals in regard to referral to self-help groups. Research Questions The purpose of the study was addressed through the following three research questions: 1. How do professionals in gerontology view the prevalence of alcoholism among the elderly? 2. What are the attitudes of professionals in gerontology in regard to treating elderly alcoholic patients? 3. What are the attitudes of professionals in gerontology in regard to referring their elderly alcoholic patients to self-help groups? Methodology The study used a 29-item, researcher-drafted questionnaire, mailed to 200 professionals in gerontology, who were members of the American Society on Aging (ASA) and residing in California, Arizona, and Nevada. The items in the questionnaire were used to determine their views on the Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. prevalence of alcoholism among the elderly, their attitudes toward treating alcoholic patients, and their attitudes toward referring such patients to self- help groups. In addition, the questionnaire was used to gather demographic data in regard to professional education and status, alcohol education, and attitudes toward alcohol education, as well as sex, age, and ethnicity. Specifically, there were four items on views on prevalence, two items on attitudes toward treating alcoholic patients, and three items on attitudes toward referring such patients to self-help groups. The remaining 20 items concerned demographic data. Delimitations The study was delimited to professionals in gerontology who were members of ASA and who resided in California, Arizona, and Nevada. As such, the generalizability of the findings is limited to this geographic region. Definitions of Terms Alcohol abuse is defined as pathological dependency, physiological dependency, alcohol tolerance, major alcohol-related illness, and continued drinking despite strong contraindications (The National Council on Alcoholism, 1996). Alcohol dependence is a syndrome involving at least three of the nine core symptoms of alcohol abuse (as defined by the DSM-IV. The most 6 Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. prevalent symptoms are tolerance and withdrawal (The National Council on Alcoholism, 1996). Earlv-onset alcoholic refers to “ someone who has abused alcohol throughout life and is not chronically aged" (Mellor et al., 1996, p. 73). Late-onset alcoholic refers to "someone who only now, in old age, has begun problem-drinking and manifests a problem with alcohol” (Mellor et al., 1996, p. 74). Organization of the Remainder of the Study This chapter provided an overview of the study. Chapter 2 presents a review of the literature relevant to alcoholism among the elderly. Chapter 3 provides the methodology, including a description of the participants, procedure, instrumentation, data analysis, and limitations. Chapter 4 presents the results, and Chapter 5 includes a discussion of the findings, conclusions, and recommendations for further research. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. CHAPTER 2 REVIEW OF THE LITERATURE This chapter presents the research relevant to alcoholism among the elderly. The chapter begins with a definition of elderly alcoholism. This is followed by a discussion of physiological and psychological impairments, attitudes toward the elderly alcoholic, prevalence, early-onset versus late- onset, detection and diagnosis, and treatment. The chapter concludes with a section on the role of the professional. Definition of Elderly Alcoholism The Council (1996) has compiled an extensive amount of research on the various aspects of alcoholism in the elderly, including definitions and epidemiology, age-related effects of alcohol use, diagnostic approaches, treatment considerations, prevention opportunities, and recommendations. The emphasis of the research was on attitudes toward alcoholism and the elderly which can be obstacles to identification, diagnosis, and treatment. Gomberg (1982 as cited in Council on Scientific Affairs of the U.S. Department of Health Services, 1996) presented the relevant criteria for a Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. definition of elderly alcoholism which includes “ falls or accidents, nutritional inadequacy, family problems (including social isolation), and most of all, medical problems associated with heavy alcohol intake” (p. 797). Mellor et al. (1996) list the special characteristics of alcoholism among the elderly, including the elderly's altered tolerance for alcohol, a lack of detection and misdiagnosis, interaction with prescription medications, dual abuse of alcohol and prescription drugs, societal biases, and cultural beliefs. In regard to this last characteristic, the researchers state the importance of cultural awareness and sensitivity among helping professionals. The Council (1996) also stated that longitudinal research has shown that heavy drinking among the elderly takes its toll in physiological and psychological impairments. Notably, “aging modifies the body's responsiveness to alcohol and other substances” (p. 798). Physiological and Psychological Impairments Alcoholism among the elderly can result in the need for certain nutrients; it can cause cirrhosis of the liver; cancers of the mouth, larynx, and esophagus, especially among those who smoke; elevated systolic blood pressure; fractures; interactions with prescription medications; seizures and falls; and cognitive deterioration. The researchers noted, however, that one has to be cautious in drawing such conclusions as there is little agreement about whether alcohol or aging plays the dominant role in 9 Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. such problems. The Council (1996) also points out that the psychological effects are just as significant. In particular, alcoholism and depression have been implicated in suicides and suicide attempts by the elderly. The Council (1996) also provides an overview of the issues relevant to alcohol abuse and dependence among the elderly, including secondary physical and psychiatric problems, diagnosis, and treatment. Secondary physical problems can also include malnutrition, cirrhosis of the liver, osteomalacia, cardiomyopathies, atrophic gastritis, and a decline in cognitive status, specifically a decline in memory and information processing. The Council (1996) felt that the central problem in the elderly alcoholic was the potential for addiction and tolerance, with concomitant withdrawal symptoms when drinking ceases. Secondary psychiatric problems can include major depression, paranoid and suicidal ideation, and an increased risk of suicide. Attitudes Toward the Elderly Alcoholic The Council on Scientific Affairs of the U.S. Department of Health Services (1996) believes that attitudes toward alcoholism and aging by the patient, physician, and family “can be formidable obstacles to identification, diagnosis, and treatment” (pp. 798-799). They pointed out that physicians may be reluctant to accept clinical responsibility for patients who are both elderly and alcoholic and that, even when they do, they are unsure of how Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. to address alcohol problems in the elderly. The Council (1966) states that, overall, one of the greatest barriers has been “a payment climate that discourages elderly alcoholic patients from seeking help and fails to reimburse physicians adequately" (p. 799). Hooyman and Kiyak (1993) discussed the prevalence of alcoholism among the elderly, and pointed out that it is difficult to obtain accurate statistics due to the stigma attached to alcoholism among this cohort. Surveys of elderly outpatients estimate that 15% to 30% of the elderly show symptoms of alcoholism. Such surveys also show that approximately equal proportions of the elderly alcoholics who began drinking before age 40, and those who began drinking in old age, often drink in response to age-related isolation and stress. Prevalence Caracci and Miller (1991) present the results from the Epidemiological Catchment Area Study-the largest community prevalence study of alcoholism in the elderly (approximately 4,600 subjects, 60 years of age and older). The study found a decreased prevalence of heavy drinking in the elderly. However, they point out that a large number of long-term alcoholics may have died from the medical complications of drinking. The study found that the prevalence rates of geriatric alcoholism are 11 Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. approximately 20%. However, the percentage varies by study, depending on the methodology employed in the research. Schuckit (1988) also addressed the prevalence of the problem, as well as the identification of the older alcoholic, the usual course of alcoholism in older people, and the treatment of the older alcoholic. In regard to prevalence, Schuckit noted that the rate of alcohol abuse among the elderly is not precisely known, in part because the diagnostic criteria have been established for a younger population. However, the general consensus is that between 1% and 3% of women and 5% and 12% of men over the age of 60 are likely to have problems with alcohol. Further, it is estimated that at ieast 10% to 20% of the elderly seen by geriatric outreach agencies, or residing in nursing homes, would fulfill the criteria for alcoholism, as would 20% to 40% of the elderly in psychiatric clinics and 20% to 60% of the elderly seeking acute medical care. Schuckit (1988) believes it is hard to identify the elderly alcoholic because of stereotypical views. Oftentimes, because of the age of these individuals, they are less likely to be working and thus to lose a job due to alcohol. Further, they are more likely to be living alone, making it less likely for a significant other to complain about their alcoholism. In addition, the family may be reluctant to bring the elderly member in for treatment due to the "shame” of having an alcoholic family member. 12 Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. Mellor et al. (1996) also pointed out the factors that make it difficult to determine the number of elderly alcoholics. These factors include their social isolation, the desire of family, friends, and even professionals to protect the elderly person from being labeled as an alcoholic, and a general lack of understanding of the seriousness of the problem. Despite the difficulty in determining the incidence of alcohol abuse among the elderly, Mellor et al. noted that, once identified as an alcoholic, the elderly “complete treatment more often than their younger counterparts, especially when treatment includes peer counseling and support’ (p. 73). Earlv-Qnset Versus Late-Qnset Schuckit (1988) noted that among elderly alcoholics, approximately one-half do not begin to develop severe alcohol-related life problems until they are in their forties, fifties, or sixties. This may be because individuals who have an earlier onset of alcoholism are not likely to live into their sixties. The researcher also pointed out that a later age of onset may be related to specific stressors associated with old age. Caracci and Miller (1991) believe that late-onset alcoholism, generally in response to stressful experiences, is the more prevalent of the two subtypes. However, they also point out that there is research to the contrary. 13 Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. While most researchers discuss two categories of alcoholism among the elderly, Mellor et al. (1996) distinguish four categories of elderly alcoholism whose criteria involve the length and patterns of their drinking history. The early-onset drinker is “someone who has abused alcohol throughout life and is now chronologically aged” (p. 73). This group is likely to have life-threatening medical problems, as well as psychological problems. The late-onset, or reactive drinker, is “someone who only now, in old age, has begun problem drinking and manifests a problem with alcohol" (p. 74). Within this group is a third category of lifelong heavy drinkers “ who lapse into alcoholism once the gatekeepers (of job and family) are removed and the grief-producing events of old age are experienced” (p. 74). Finally, there is the smaller category of intermittent drinkers or “those who are periodic binge drinkers but otherwise abstain or drink moderately" (p. 74). Detection and Diagnosis Caracci and Miller (1991) note that alcoholism among the elderly is less likely to be detected than in younger individuals. This is partially due to the difficulty of applying the usual diagnostic criteria to individuals over the age of 60. Part of the reasons is because the emphasis the DSM-III-R (Diagnostic and Statistical Manual of Mental Disorders, third edition, revised) places on problems related to drinking as a means to make a 14 Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. diagnosis of alcoholism are poorly applicable to the elderly, who are no longer working and tend to be socially isolated. Caracci and Miller (1991) recommended that clinicians rely on their diagnostic acumen to diagnose alcoholism in the elderly. This includes such criteria as blackouts, memory losses, frequent falls or accidents, general debilitation, neglect, and medical problems. The Council (1996) feels that the diagnostic assessment hinges on the taking of a thorough history. Information from the patient should be supplemented with information from family members from at least two generations. During the physical examination, the physician needs to screen for medical conditions that could aggravate the effects of alcohol abuse. Finally, a laboratory evaluation should include standard liver function studies and an electrocardiogram. The Council (1996) suggests the use of multiple diagnostic procedures, including a physical examination, laboratory tests, a mental status examination, and a history taken of recent and past alcohol, tobacco, and other drug use, including prescription medications. In addition, the patient’s attitudes toward aging should be explored. The Council also recommends that physicians should become familiar with self-administered screening instruments. Finally, the researchers point out that clinicians need to break through the patients' denial. 15 Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. Treatment In terms of treatment, The Council (1996) believes that the greatest challenge is detoxifying elderly patients who have coexisting medical problems. In general, an inpatient setting is required; however, uncomplicated detoxifying procedures can be managed in an outpatient setting. Medical treatment should include fluid and electrolyte therapy as well as pharmacotherapy. Diazepam is a commonly used drug as it has a high therapeutic:toxic effects ratio. In addition, self-help groups such as Alcoholics Anonymous are recommended as a therapeutic adjunct. The Council (1996) points out that in choosing treatment settings and modalities for elderly patients, physicians should look for programs that provide treatment to specific age groups. In addition, treatment programs that emphasize social relationships demonstrate better outcomes for the elderly than the more traditional programs. Treatment efforts, according to Schuckit (1988), should be aimed at alleviating the symptoms of detoxification, maximizing and maintaining high levels of commitment to abstinence, and helping the individual rebuild his or her life. All elderly alcoholics need to go through a detoxification period. Then, once the physical issues are addressed, rehabilitation becomes the concern. Generally, rehabilitation programs concentrate on education, outreach to the family, and group counseling. Alcoholics Anonymous is one 16 Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. form of group counseling and is the most effective when the group includes other elderly individuals. Finally, Solomon, Manepalli, Ireland, and Mahon (1993) believe that the core of a treatment plan for the elderly alcoholic should be based on the 12-step model of Alcoholics Anonymous. They point out that elderly alcoholics are as successful as their younger counterparts in such programs and that those in age-specific group treatment programs tend to remain in treatment longer. Solomon et al. (1993) state that treatment should follow a series of stages. The first step is abstinence, medical detoxification, and the treatment of withdrawal symptoms. The second stage is the admission by the elderly patient of their alcoholism. In this stage, both the elderly patient and the family learn that addiction is an illness and not a breakdown of morals. The third stage is compliance. The patient is asked to do a review of the effects of alcoholism on their life. The elderly patient is introduced to literature from Alcoholics Anonymous during this stage.. The fourth stage is acceptance. The elderly patient starts to try to reverse some of the problems that developed from their alcoholism. The patient starts to attend Alcoholics Anonymous meetings and is introduced to the concept of powerlessness over their alcoholism. The final stage of treatment involves surrender. During this stage, the patient is able to move 17 Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. out of the hospital and starts to move up the ladder through the 12 steps of the program. Solomon et al. (1993) state that other treatment modalities may be helpful in maintaining abstinence and sobriety. Finally, the researchers encourage the patient to maintain close ties with their family and to develop a non-drinking social support system. The Role of the Helping Professional Helping professionals working with the elderly alcoholic need to enable the patient overcome barriers to treatment. Hooyman and Kiyak (1993) note that the elderly person may justify his or her drinking by claiming that it relieves sadness. Further, family members may minimize an elderly family member’s drinking by rationalizing that it is one of the person's few remaining pleasures. Moreover, denial is a common problem among elderly alcoholics who grew up under the influence of Prohibition in the 1920s and may have received a strong message that alcoholism is a moral problem. Finally, many elderly people believe that they need to be self-reliant, and to be able to cope with their alcoholism by themselves. As such, they are reluctant to rely on health professionals or to join support groups such as Alcoholics Anonymous. Sumberg (1985a) outlines the parameters of the problems surrounding the elderly alcoholic and suggests some practical treatment 18 Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. approaches. He points out that alcoholics have traditionally been considered the “refuse” of our society. Further, current research on alcoholism has generally excluded the elderly. Sumberg's (1985a) main focus is on issues in treatment. He discusses the importance of educating social workers and other professionals who work with elderly alcoholics, that the results of alcoholism among the elderly are never benign and that the elderly alcoholic is not a hopeless case. He further states that the most frustrating aspect of working with the elderly alcoholic is their denial. Further, social workers may feel ambivalent about asking the elderly to experience yet another loss-by giving up their alcohol. Sumberg (1985a) advocates outreach and education, not only with the elderly themselves, but also with other individuals and community organizations. He advocates the use of self-help groups comprised of peers who understand the elderly alcoholic's experiences. Treatment, for Sumberg, starts with identifying the alcoholic. The next steps involve encouraging recognition by the client, dealing with denial, meeting concrete needs, monitoring recovery, providing support services, and dealing with the loss of alcohol. In regard to support services, Sumberg emphasizes that the social worker or other professional should steer the elderly alcoholic toward support groups. 19 Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. Newman-Aspel (1988) led a long-term psychodynamically oriented support group for elderly adults suffering from alcoholism. She presents two vignettes: one of individual and one of family work, which demonstrate the possibility of achieving success even when a patient uses denial and has little or no motivation to change. The first case involved a married couple in their late sixties who had been married for 25 years. The wife had recently attempted suicide, using her husband’s alcohol, and the husband was deep in denial about his own drinking. The wife felt neglected and like “a maid” to her husband, who “tuned her out." During their treatment session, the husband stated that in terms of alcohol, he could “take it or leave it." However, by the following week, it was clear that he was an alcoholic. Newman-Aspel (1988) told him that he needed to attend Alcoholics Anonymous, which he did. Within two weeks he stopped drinking and was more responsive to his wife. This set up a positive feedback loop between the husband and wife. The second case involved a 74-year old woman who had been drinking for at least 30 years. Her son and daughter-in-law described her as an “intimidating, ice-water in her veins despot," (Newman-Aspel, 1988, p. 111) who could dismiss anyone who dared to displease her. Newman- Aspel’s intervention plan included the involvement of the son and daughter- in-law who were to document instances of the woman’s inappropriate behavior. In addition, they were asked by Newman-Aspel to tell the woman 20 Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. what her drinking was doing to their relationship as well as to her health. Moreover, should she refuse treatment, her son would not have anything further to do with her. With the cooperation of her son and daughter-in-law, the woman was able to recover. Amodeo (1988) provides strategies for working with elderly alcoholics. In particular, she addresses three aspects: features of late life that affect alcohol use, understanding denial and motivating the patient to change, and strategies for working with families and groups. The features that affect alcohol use include the following: • A metabolism in which the liver becomes less likely to work efficiently. • Physical fragility due to aging, including problems with balance, coordination, as well as vision, color and sound perception, and a slowing of reaction time. • Medications taken incorrectly or combined with alcohol. • Countertransference related to negative stereotypes of problem drinkers and alcoholics. • Countertransference related to stereotypes of the elderly, including caregivers having a difficult times seeing alcoholism among the elderly. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. • Overidentification with the children of the alcoholic and alliance with them against the elderly drinker. Amodeo (1988) then turns her attention to understanding denial and views it as an unconscious response to pain. The elderly alcoholic has an inability, not simply an unwillingness, to face the truth. As such, the clinician must remember that the elderly alcoholic’s denial is not an attempt to thwart the clinician’s desire to help. One role of the clinician in working through denial is to help the individual accept some form of specialized treatment which can include detoxification, a counseling or rehabilitation program, or a self-help group such as Alcoholics Anonymous. Amodeo (1988) offers nine step-by-step guidelines for working through denial. Finally, Amodeo notes that, in general, older alcoholics and their families do best with a combination of specific alcoholism treatments, including Alcoholics Anonymous and Al-Anon, as well as other group and individual and family approaches. She concludes by stating that it is essential that the message be conveyed that alcoholism is a treatable condition and that recovery, while difficult, is likely if the elderly individual makes use of the many supports available. 22 Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. CHAPTER 3 METHODOLOGY The chapter begins with a presentation of the participants. This is followed by the procedure, instrumentation, data analysis, and limitations. The chapter concludes with a discussion of the limitations. Participants As noted in Chapter 1, the purpose of the study was to determine current views and attitudes, particularly in regard to prevalence and treatment, among professionals in gerontology. An additional purpose was to determine the attitudes of such professionals in regard to self-help groups. As such, the researcher decided to select participants from an organization concerned with the needs of the elderly. After perusing the mission statements of a number of organizations concerned with the elderly, the researcher selected the American Society on Aging (ASA) from which to draw the study participants. The contact person for the ASA was Ms. Marcia Freedman, Vice President of Public Relations and Public Information. 23 Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. ASA was founded over 40 years ago, at which time it was known as the Western Gerontological Society. Currently, ASA has over 10,000 members nationwide who consist of clinicians, policy specialists, researchers, educators, and others who have an interest in aging and the elderly. ASA has an annual conference and publishes numerous publications yearly. Ms. Freedman agreed to provide the researcher with 200 randomly selected names from the rosters for California, Arizona, and Nevada. The method of randomization was left up to Ms. Freedman, however, she was informed that students and retired professionals were to be excluded from the randomly selected participants. The randomization process was continued until 200 participants were selected. Procedure Each of the 200 participants was sent a 29-item questionnaire which was developed by this researcher, along with a cover letter explaining the purpose of the study and the questionnaire. A stamped, self-addressed return envelope also was included. The letter, questionnaire, and return envelope fit into a business size envelope. After approximately three weeks, reminder postcards were sent to those individuals who had not yet returned their questionnaire. A total of 100 usable questionnaires were returned. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. Instrumentation As noted above, the questionnaire (Appendix A) contains 29 items. The items in the questionnaire were used to determine the participants’ views on the prevalence of alcoholism among the elderly, their attitudes toward treating alcoholic patients, and their attitudes toward referring such patients to self-help groups. In addition, the questionnaire was used to gather demographic data in regard to professional education and status, alcohol education, attitudes toward alcohol education, and sex, age, and ethnicity of the participants. Specifically, there were four items on views on prevalence, two items on attitudes toward treating alcoholic patients, and three items on attitudes toward referring such patients to self-help groups. The remaining 20 items concerned the demographic data. The breakdown by items is presented below: Section I, items 1 through 5, concerned sex, age, ethnicity, and education. Section II, items 6 through 12 included current and past professional status. Section III, items 13 through 16 concerned views on prevalence of alcoholism among the elderly, and items 17 and 18 included attitudes toward treating elderly alcoholic patients. Section IV, items 19 through 23 concerned alcohol education. Section V, items 24 through 26 included attitudes toward alcohol education. Finally, Section VI, items 27 25 Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. through 29, concerned attitudes toward referring elderly alcoholic patients to self-help groups. Data Analysis The items involved choosing the appropriate response, filling in the information, or indicating one’s position on a Likert-type scale. As such, data analysis used frequency counts for the items involving choosing a response and filling in the information and ranges and mean values for items which involved a Likert-type scale. Limitations As noted in Chapter I, the sample was delimited to participants in California, Arizona, and Nevada. In addition, as will be discussed in the following chapter, the results indicated that the majority of the participants were women and Caucasian. As such, the generalizability of the results is limited to, in general, Caucasian female professionals in gerontology residing in the above-mentioned delimited geographic area. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. CHAPTER 4 RESULTS This chapter presents the results of the data analysis. As noted in Chapter I, the purpose of the study is to determine current views and attitudes, particularly in regard to prevalence and treatment, among professionals in gerontology. An additional purpose is to determine the attitudes of such professionals in regard to self-help groups. The 29 questionnaire items involved choosing the appropriate response, filling in the information, or indicating one’s position on a Likert- type scale. As such, the data analysis used frequency counts for the items involving choosing a response and filling in the information and ranges and mean values for items which involved a Likert-type scale. The presentation of the results is organized as follow. The demographic data is presented. This is followed by the data relevant to the three research questions which concern how professionals in gerontology view the prevalence of alcoholism among the elderly, the attitudes of professionals in gerontology in regard to treating elderly alcoholic patients, 27 Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. and the attitudes of professionals in gerontology in regard to referring their elderly alcoholic patients to self-help groups. Demographic Data The demographic data concerned professional education and status, alcohol education, and attitudes toward alcohol education, as well as sex, age, and ethnicity. Specifically, there were four items on views on prevalence, two items on attitudes toward treating alcoholic patients, and three items on attitudes toward referring such patients to self-help groups. The remaining 20 items concerned the demographic data. There was a total of 105 participants. Their ages ranged from 27 to 87, with a mean of 47.59 years. Tables 1 through 7 present the various demographic data. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. Table 1 Demographic Data—Sex and Ethnicity Participants Percent Number Sex Female 82.86 87 Male 12.38 13 Unspecified 4.76 5 Ethnicity Caucasian 81.90 86 Asian-American 4.76 5 African-American 3.81 4 Hispanic 3.81 4 ; Native-American .95 1 Did not indicate 4.75 5 Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. Table 2 Demographic Data—Education Education Percent Number Master's Degree 50.48 53 Bachelor's Degree 19.05 20 Ph.D. 9.52 10 Two Master's Degrees 6.67 7 A.A. Degree 4.76 5 M.D. Degree 3.81 4 High School Diploma .95 1 Did not indicate 4.76 4 Field of Study Social Work 22.86 24 Gerontology 19.05 20 Psychology (Counseling) 13.33 14 Business 7.62 8 Public Admin, or Business Management 7.62 8 Public Health 4.76 5 Allied Health 3.81 4 Nursing 3.81 4 Medicine (generally as physicians) 1.86 3 Did not indicate 6.67 7 Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. Table 3 Demographic Data—Employment Employment Percent Number Full-time 60.95 64 Part-time 21.90 23 Not employed 6.67 7 Volunteers 5.71 6 Did not indicate 4.76 5 Human Services Performed client services 21.90 23 In administration 21.90 23 Provided family services 7.62 8 In advocacy 2.86 3 Evaluated programs 1.90 2 Policy 0 0 Did not indicate 9.52 10 Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. The following data represents their current job and their role within their current job. Table 4 Demographic Data— Current Job Current Job Percent Number Middle Managers 27.64 29 Social Workers 12.38 13 Senior Managers 10.48 1 1 Counselors 6.67 7 Instructors 5.71 6 Line Managers 5.71 6 Specialists 3.81 4 Technicians 3.81 4 Nurses 1.86 3 Psychologists 2.86 3 Researchers 1.90 2 Physician .95 1 Other 7.62 8 Did not indicate 7.62 8 Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. Table 5 Demographic Data—Role in Current Job Role in Current Job Percent Number Managers 28.57 30 Counseling or Discharge planning 12.38 13 Counseling or therapy 8.57 9 Decision Makers 8.57 9 Assistant Directors 6.87 7 Taught 6.87 7 Highly Qualified Senior Staff 4.76 5 Less Experienced Personnel 2.86 3 Administered Tests 2.86 3 Researchers 2.86 3 Nurses 1.90 2 Diagnosed Patients .95 1 Other 5.71 6 Did not indicate 6.67 7 Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. In regard to length of time on the job, the range was 1 to 35 years, with a mean of 4.88 years. The length of time on previous jobs had a similar mean. Table 6 Demographic Data— Organizations Worked Organizations Worked Percent Number Adult Day-Care Center 17.14 18 Hospital 11.43 12 Non-Profit Organization 10.48 11 Schools 10.48 11 Senior Center 10.48 11 Local Agencies 9.52 10 HMO 5.71 6 Other Government Agencies 5.71 6 Private Organizations 4.76 5 Did not indicate 14.29 15 Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. Overall, 51.43% (54) of the participants worked with the elderly at least half of the time. Table 7 Demographic Data— Time Spent Working With Elderly Time Spent Percent Number Zero Percent 20.0 21 100 Percent 19.05 20 80 Percent 17.14 18 40 Percent or 60 Percent 11.43 12 20 Percent 9.52 10 10 Percent 4.75 5 90 Percent 2.86 3 3, 13, 30 or 55 Percent .95 1 each Overall, the participants ranged in age from 27 to 87, with a mean of 47.59 years. The participants were predominately female and Caucasian, over half had at least a master's degree and most were in social work, gerontology, or psychology. They worked full time in client services or administrative positions. The length of time at their jobs was 1 to 35 years, 35 Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. with a mean of 4.88 years, and most worked in adult-day care centers, hospitals, non-profit organizations, schools, and senior centers. Finally, at least half of the participants worked with the elderly at least half of the time. Perceived Prevalence of Alcoholism Among the Elderly The questions which pertain to this issue were answered on a Likert- type scale, with 1 being the least prevalent and 4 being the most prevalent. In regard to how frequently the participants saw clients with an alcohol problem, the responses ranged from 1 to 4, with a mean of 2.69, which is between “rarely” and “occasionally.” In terms of how often professionals in the field of aging come into contact with alcohol problems, the responses ranged from 1 to 4, with a mean of 3.39, which is between “occasionally" and “ frequently.” For the extent to which older persons have alcohol problems, the responses ranged from 1 to 4, with a mean of 3.22, which is between “a slight problem" and “a serious" problem. In response to what participants foresaw in regard to the number of elderly with alcohol problems, the Likert-type scale ranged from 1 to 3. The responses ranged from 1 to 3, with a mean of 2.67, which is between “no change" and “an increase." 36 Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. For the question about participants' feelings about working with an elderly client who had an alcohol problem, the Likert-type scale ranged from 1 to 3. The responses ranged from 1 to 3, with a mean of 2.28, which is between “no preference” and “it would be all right.” For the question about whether professionals who are serving such elderly clients are as satisfied with their handling as they are with their other cases, the Likert-type scale ranged from 1 to 4, with a mean of 2.00, which corresponds to “possibly not.” Overall, participants felt that alcoholism among the elderly occurs from “rarely” to “occasionally,” is a “slight” to “serious" problem, and the prevalence of alcoholism among the elderly is expected to have either “no change" or “an increase." In regard to working with such clients, there was either “no preference" or “it would be all right," and they indicated that the professionals who work with such clients are “possibly not” satisfied with their handling of these cases. Alcohol Education Of the participants, 50.48% (53) had received alcohol education, 41.90% (44) had not, and 7.62% (80) did not respond. In terms of the type of education, 47.13% (41) indicated a workshop, 19.54% (17) indicated a classroom video, 11.49% (10) indicated a certificate program, 10.34% (9) 37 Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. indicated a master’s degree, 5.75% (5) indicated a doctoral degree, 4.60% (4) indicated a bachelor’s degree, and 1.15% (1) indicated an A.A. degree. In regard to alcohol training certification, 85.76% (89) indicated not having such certification, only 2.86% (3) indicated such certification, and 12.38% (13) of the participants did not respond to this question. In regard to the year of their most recent alcohol education, only those participants who received this type of education were able to answer this question. Of these 54 respondents, 79.63% (43) had been involved in alcohol education within the past 10 years and of these, 50.0% (27) had involvement in alcohol education within the past five years. In regard to the usefulness of such education, of the 7 respondents who answered, 85.71 % (6) felt that it was useful and 14.29% (1) did not feel that it was useful. Overall, at least half of the participants had received alcohol education, generally in the form of a workshop or a classroom video. However, the overwhelming majority did not have alcohol training certification. Of those who did receive alcohol education, the majority received such education within the past ten years, and the overwhelming majority felt that such education was useful. Attitudes Regarding Alcohol Education In regard to whether the participants recommended alcohol education to someone else, 66.67% (70) indicated “yes,” only 5.71% (6) 38 Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. indicated “no,” and 27.62% (29) of the participants did not respond. In terms of to whom they recommended such education, the participants were asked to check as many responses as apply. The results indicated that 26.43% (74) recommended it to professionals, 25.0% (70) recommended it to current professionals in the helping field, 24.64% (69) recommended it to students planning to enter the helping professions, and 23.93% (67) recommended it to students in the social work field. In regard to the availability of alcohol education, potential responses ranged from 1 (“none”) to 4 (“very"). The participants’ responses ranged from 2 to 4, with a mean of 2.65, which is between “limited" and “somewhat.” Overall, the majority of the participants recommended alcohol education. In regard to whom they recommended such education, the responses were nearly evenly split between students planning to enter the helping professions, current professionals in the helping field, students in the social work field, and professionals who work with the elderly. In regard to the availability of alcohol education, the participants viewed it as “limited” to “somewhat" available. Referrals to Self-Help Groups In terms of familiarity with the self-help programs for alcoholics, 84.76% (89) of the participants indicated familiarity, 8.57% (9) indicated that they were not familiar with such programs, and 6.67% (7) of the participants 39 Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. did not respond. In regard to whether they felt that self-help groups are a viable alternative to professional services, 69.52% (73) indicated that they believe such self-help groups are a viable alternative to professional services, 18.10% (19) indicated a lack of belief in such self-help groups, and 12.38% (13) of the participants did not respond. Finally, in regard to whether they would refer a client to a self-help group for an alcohol problem, 83.81% (88) indicated that they would, 3.81% (4) indicated that they would not, and 12.38% (13) of the participants did not respond to the question. Overall, the majority of respondents was familiar with self-help programs for individuals with alcohol problems and saw them as a viable alternative to professional services. In addition, an overwhelming majority would refer elderly alcoholic clients to such self-help groups. Summary This chapter presented the results of the data analysis of the questionnaire. Overall, the participants ranged in age from 27 to 87, with a mean of 47.59 years. The participants were predominately female and Caucasian, over half had at least a master's degree and most were in social work, gerontology, or psychology. They worked full time in client services or administrative positions. Their length of time at their jobs was 1 to 35 years, with a mean of 4.88 years, and most worked in adult day-care 40 Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. centers, hospitals, non-profit organizations, schools, and senior centers. At least half of the participants worked with the elderly at least half of the time. Regarding the perceived prevalence of alcoholism among the elderly, participants felt that alcoholism among the elderly occurs from “rarely" to “occasionally," is a “slight" to “serious" problem, and the prevalence of alcoholism among the elderly is expected to have either “no change" or “an increase.” In regard to working with such clients, there was either “no preference” or “it would be all right," and they indicated that the professionals who work with such clients are “possibly not” satisfied with their handling of these cases. In terms of alcohol education, at least half of the participants had received such education, generally in the form of a workshop or a classroom video. However, the overwhelming majority did not have alcohol training certification. Of those who did receive alcohol education, the majority received such education within the past ten years, and the overwhelming majority felt that such education was useful. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. CHAPTER 5 DISCUSSION, CONCLUSIONS, AND RECOMMENDATIONS This chapter takes the findings from the previous chapter and discusses them in the context of the literature reviewed, as well as develops conclusions and recommendations for further research and for the field of gerontology. The chapter begins with a summary of the important findings The participants ranged in age from 27 to 87, with a mean of approximately 48 years, and were predominantly female and Caucasian. Over half had at least a master’s degree and worked in social work, gerontology, or psychology. Participants felt that alcoholism among the elderly occurs rarely to occasionally, is a slight to serious problem, and the prevalence of alcoholism among the elderly is expected to remain the same or increase. In regard to working with such clients, the participants either had no preference or felt comfortable, but indicated that the professionals who work with such clients may not be satisfied with the handling of these cases. At least half of the participants had received alcohol education, generally in the form of a workshop or a classroom video, and the majority 42 Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. felt that such education was useful and would recommend it to both students and professionals. However, the majority of those who had alcohol education did not have alcohol training certification. Further, they saw opportunities for alcohol education as limited and as somewhat available. Finally, the majority of participants were familiar with self-help programs for alcoholics and felt comfortable referring elderly alcoholic clients to such self-help groups. Discussion Overall, the participants saw alcoholism among the elderly as relatively uncommon, but did express that it could be serious and its prevalence could increase. They also indicated that they would be relatively comfortable working with such clients, but indicated that those who work with such clients may not be satisfied with their handling of such cases. Yet, only a little more than half had received alcohol education, and, thus, many of the participants may not have had sufficient alcohol education to even detect alcoholism among the elderly. Further, even those professionals who had received this type of education may not have had specific training in detecting and diagnosing alcoholism among the elderly. As noted in the literature, there are a number of obstacles to determining the prevalence of the problem, as well as to detection and diagnosis. Hooyman and Kiyak (1993) note that it is difficult to obtain 43 Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. statistics due to the stigma attached to alcoholism among this cohort. Schuckit (1988) points out that the rate of alcohol abuse among the elderly is not precisely known, in part because the diagnostic criteria have been established for a younger population, and in part because stereotypical views of the elderly alcoholic interfere with the ability to identify them. Mellor et al. (1996) state that certain factors make it difficult to determine the number of elderly alcoholics, including their social isolation, the desire of family, friends, and even professionals to protect elderly individuals from being labeled as alcoholic, and a general lack of understanding of the seriousness of the problem. All these considerations may have been factors in the responses of the participants. Concerning treatment, the majority of the participants were familiar with self-help programs for alcoholics and would refer elderly alcoholic clients to such self-help groups. This finding is in keeping with Solomon et al. (1993) who believe that the core of a treatment plan for the elderly alcoholic should be based on the 12-step model of Alcoholics Anonymous. Further, Sumberg (1985a) emphasized that professionals working with elderly alcoholics should steer them toward support groups. Finally, Amodeo (1988) noted that elderly alcoholics do best with a combination of specific alcoholism treatments including Alcoholics Anonymous and Al- Anon, other group and individual interaction, and family approaches. 44 Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. Conclusions Based on the findings of this study, as well as the research presented in the review of the literature, it appears important to emphasize two areas of need. The first area is the need for alcohol education to enable professionals in gerontology to detect and diagnose alcoholism among the elderly. The second area is the need for support groups for elderly alcoholics. Recommendations for Further Research The following recommendations for further research are drawn from the delimitations and limitations of the present study, as well as the two areas of need identified above: 1. The present study was delimited to professionals in gerontology who were members of ASA and who resided in California, Arizona, and Nevada. Further research needs to survey professionals in gerontology who reside in more diverse geographic regions to see if the results of the present study are applicable to other regions. 2. The participants in the present study were primarily female and Caucasian. Further research needs to survey greater numbers of male professionals in gerontology, as well as professionals from more diverse racial/ethnic groups. 45 Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 3. In the present study, participants reported that alcohol education was presented primarily through workshops or classroom videos. Research needs to be conducted to determine what is being taught in alcohol education, whether the knowledge gained is adequate to providing client services, and what, if anything, needs to be added to the alcohol education curriculum. Clearly, the present study suggests that the curriculum should contain a component on alcoholism among the elderly. 4. Research needs to be conducted to determine by what criteria professionals in gerontology are detecting and diagnosing alcoholism among the elderly. Related to this, criteria specific to elderly alcoholism need to be developed and formalized into Diagnostic and Statistical Manual of Mental Disorders (DSM) criteria. 5. Finally, evaluative research could be conducted to further support the usefulness of self-help groups such as Alcoholics Anonymous for the elderly. One potential avenue is the Veterans Administration hospitals, some of which provide treatment programs geared toward the elderly alcoholic, separate from other alcoholics. Recommendations for the Field of Gerontology The following recommendations for the field of gerontology are drawn from the areas of need identified above: 46 Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 1. The most important concern among professionals in gerontology should be prevention. Prevention, in turn, is related to education. Education regarding the detection and diagnosis, as well as the prevention of alcoholism among the elderly, need to occur on several levels, including professionals in gerontology, physicians, health-care workers, family members of the elderly, the public, and even the elderly themselves. Because of the relative isolation of the elderly, family members, as well as individuals in the community, need to be aware of the signs and symptoms of alcoholism among the elderly. Such family members and individuals can aid in detection and diagnosis. Importantly, education begins with educating the educators in the field of gerontology as well as related fields that deal with elderly individuals. 2. Another important concern is the availability of support groups, both for the elderly alcoholic and for elderly individuals in general. Support groups can serve a variety of purposes. Support groups for elderly individuals can prevent the isolation that is one of the causes of, and contributors to, alcoholism among the elderly. In addition, support groups can provide a forum for educating the elderly by having speakers on such areas as physical and mental health, coping with loss, and legal issues. Such support groups could be run by senior centers. Staff members, in particular, should receive education on alcoholism among the elderly. 47 Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. Further, as has been emphasized, there is a great need for 12-step support groups for elderly alcoholics. 3. Given that many of the elderly are isolated and may be without transportation, it is important for professionals in gerontology to ensure that in-home visits to the elderly are conducted. Such in-home visits also could include interviews with family and neighbors. This provides the health care giver with important information that cannot otherwise be obtained. 4. At present, there is a limited number of referral sources which professionals in gerontology can draw upon to provide services for elderly alcoholic clients. Additional referral sources need to be developed in such areas as medical management of alcoholism, specifically detoxification, as well as in psychological treatment and continuing support. 5. Finally, the above recommendations depend on funding being earmarked for prevention and treatment of alcoholism among the elderly. Professionals in gerontology need to educate legislators about the need for such funding. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. SELECTED REFERENCES Amodeo, M. (1988, October 22). Treating the late-life alcoholic: Guidelines for working through denial, integrating individual, family, and orouo approaches. Paper presented at a Scientific Meeting of the Boston Society for Gerontologic Psychiatry, Boston, MA . Caracci, G. & Miller, N. (1991). Epidemiology and diagnosis of alcoholism in the elderly (A review). International Journal of Geriatric Psychiatry. 6, 511-515. Council on Scientific Affairs (1996). Alcoholism in the elderly. Journal of the American Medical Association. 275. (10), 797-801. Hooyman, N.R. & Kiyak, H. A. (1993). Social Gerontology: A Multidisciplinary Perspective. Allyn & Bacon. Mellor, N.J., Garcia, A., Kenny, E., Lazerus, J., Conway, J.M., Rivers, L, Viswanathan, N., & Zimmerman, J. (1996). Alcohol and Aging, Journal of Gerontological Social Work. 25, 71 -89. National Council of Alcoholism (1 9§6). American Medical Society on .to , Alcoholism, Committee on Definitions. New York, NY. Newman-Aspel, M. (1988, October 22). Two cases of late life alcoholism. A paper presented at a Scientific Meeting of the Boston Society for Gerontologic Psychiatry. Boston, MA. Royce, J. E. (1981). Alcohol problems and alcoholism: A comprehensive survey. New York: The Free Press. Schuckit, M.A. (1988, October 22). Introduction: Assessment and treatment strategies with the late life alcoholic. A paper presented at a Scientific Meeting of the Boston Society for Gerontologic Psychiatry. Boston, MA. Solomon, K., Manepalli, J. Ireland, G.A., & Mahon, G.M., (1993). Alcoholism and prescription drug abuse in the elderly: St. Louis University Grand Rounds. Journal of the American Gerontological Society. 41 (1), 57-69. 49 Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. Sumberg, D. (1985a). Social work with elderly alcoholics: Some practical considerations. New York: The Haworth Press. Sumberg, D. (1985b). Social work with elderly alcoholics. Journal of Gerontological Social Work, 8, 169-180. The Merck Manual of Geriatrics. Presented on the Occasion of the 1995 White House Conference on Aging. Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. APPENDIX A COVER LETTER AND QUESTIONNAIRE Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. LEONARD DAVIS s c h o o l o f g e r o n t o l o g y ETHEL PERCY ANDRUS pERONTOLOGY CENTER <2131 7JO.SISA USC/A Survey of Alcohol Training c/o Swicegood P.O. Box 341293 Los Angeles, CA 90034-1293 April 10, 1995 Dear Member of the American Society of Aging: Recently, there have been articles and TV segments which focus attention on alcohol problems among som e of the elderly in the population. As a graduate student in Gerontology, this h a s been a topic of interest to me for quite some time. The enclosed questionnaire will collect data to be used in my thesis which is the final step for the Master's degree in Gerontology. I need your assistance with this. Enclosed please find a stamped, self-addressed envelope. I would greatly appreciate your completing the questionnaire and returning it by April 28,1995. Your contribution will be held in the strictest confidentiality. If you would like a copy of the findings, please include a 3" x 5” card pnntAvith your name and address and we will separate them immediately. Many thanks. Ursula R. Swicegood UNIVERSITY OF SOUTHERN CALIFORNIA. LOS ANGELES. CALIFORNIA YOOHI-UIH Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. ifOMAflOOAVu scfcaoLorccAaKToiocv CTNCL r a C Y 4NMUS C U O KTO U KY CXNTO A SURVEY OF ALCOHOL TRAINING t Pteese indicate your gender Fem ale M a le _____ Z Vdur m teat birthday_____ 3. What race would you consider yourself? Caucasian /fto-Amencan Hiapamc-Amencan AnarvAmanean Native American Peerfic-istander O th e r______________________ 4 Whet i* your highest degree attained? 5 What wee your field of study (major)? 6 Are you employed? FuiMime Psn-timw Mafunteer Not at ail ’ Which area m numan aervtcea would best ceecnbe wnat you currently do'’ (Check o n e ) Perform oient services . Provide family services Administer programs Evaluate programs . Provide community education Au»uuacv Policy Other _____________________ a Please deacnoe your current job Title ___________________________ Role Length of ume in (hit position'’ 9. What was your previous too? Title: _________________ Rote: length of nme m this po sitio n ? _____ 10. What was the job before that? Title- _________________________ Rote Length of time m this position? _____ 11 What kmd of organization do you worn m? 12. What percentage of your tune would you estimate you spend working with eiderty clients and/or their families? (Chech one.) t% _____ 20% 40% 60% 80% ______ 100% % 13. Horn frequently oo you see a diem with an alcohol problem? (Cheat one) Never Rarefy Don't know Occasionally Frequently 14 How often do professionals in the field of agmg come into contact with aiconoi problems? (Check one) Never Rarefy Don't know _ _ _ Occasionally Frequently 15. To whet extent do older persons nave aioonoi problems? (Check one.) No problem - An occasional oroeiem Don't k n o t _ _ A slight problem A senous problem 53 Reproduced with permission of the copyright owner. Further reproduction prohibited without permission. 16 In the coming years. do yog foresee in increase or a decrease in the number of elderly with tioorvol prooiem*? (Chock o r*.) An increase No chang# A c 17 How do you. as a professional in aging. *##t about working with a client with an alcohol prooiem? (Chock on#.) Would prefer not to No preference it would bo ail ngnt 16 Ara professionals who ara aorvmg aucn akjorty clients aa satisfistied with thair nanaiing aa (hoy aro with thoir othor cases? (Chock o n a ) No Poaaibty not O ^ rt know Somewhat Yaa 24. Would you recommend tnia specialized aducauon to aomeone else? (Chock .NO 25. To whom would you racommand this aducauon? (Chock aa many aa apply) To studonta planning to antar tra haiptng professions. To a-rrom profnaaionats m m# helping field. To studonta m tno Soaai Work field. To professionals who work with the aldorty 26. How availabla is alcohol aoucation? Vary Somownat Pont kno* Limrtad Nona 19 Have you ned any formal aiconoi aducauon? (C hackona) Yaa No 20. What form did tnia aoucation taka'’ (Chack an that apply) A oaaaroom vidao A workshop A dvtificate program An A.A. dagraa A Bachelor's dagraa A Masters dagraa A Ooctorai dagraa 2 i Oo you neve aiconoi training certification? Yaa n o 2 2 . in what year was your most recant involvement m aiconoi education'’ 23 Was tha aiconoi aducauon useful m working with clients with aiconoi orooiems? Yaa No ?? A/a you fanvliar with tha sett-ne'e programs for people with aiconoi problems? Yes No 29. Oo you faai that saif*neip groups ara a viable alternative to profeesionai services? Yas No 29 Would you refer a client to a seif-nelp group for an aiconoi prooiem? Yaa No Thank you so much for your assistance Ptaaaa return the questionnaire oy Apnl 26.1995 USC/A Survey of Aiconoi Training c/o Swicegood PO. 8 0 x 341293 Los Angelas. CA 90034-1293 54 Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.

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Asset Metadata

Creator Swicegood, Ursula Rust (author)

Core Title Alcoholism among the elderly: Fact or fallacy

School Leonard Davis School of Gerontology

Degree Master of Science in Gerontology

Degree Program Gerontology

Publisher University of Southern California (original), University of Southern California. Libraries (digital)

Tag Gerontology,health sciences, public health,OAI-PMH Harvest

Language English

Contributor Digitized by ProQuest (provenance)

Advisor Peterson, David (committee chair), Larue, Gerald (committee member)

Permanent Link (DOI) https://doi.org/10.25549/usctheses-c16-32105

Unique identifier UC11341464

Identifier 1397645.pdf (filename),usctheses-c16-32105 (legacy record id)

Legacy Identifier 1397645.pdf

Dmrecord 32105

Document Type Thesis

Rights Swicegood, Ursula Rust

Type texts

Source University of Southern California (contributing entity), University of Southern California Dissertations and Theses (collection)

Access Conditions The author retains rights to his/her dissertation, thesis or other graduate work according to U.S. copyright law. Electronic access is being provided by the USC Libraries in agreement with the au...

Repository Name University of Southern California Digital Library

Repository Location USC Digital Library, University of Southern California, University Park Campus, Los Angeles, California 90089, USA