Aging can bring out vulnerabilities, unhealthy behaviors

The golden years are supposed to be fun, a time when you've earned the chance to kick back and do what you want when and how you want to do it.

But that approach can be dangerous, especially for those with underlying addictions. Seniors who are lonely or have suffered a significant loss are especially prone to developing dangerous behaviors that until then had been lying dormant.

Doctors, family and friends commonly mistake an addiction for other problems, such as dementia or depression. And the addict is too caught up in the disease to cry for help, says Bob Hazlett, a manager for substance abuse programs at the state Department of Children and Families.

"There's shame in this," says Hazlett, who helps manage BRITE, a statewide program that identifies addiction in seniors. "They don't want to talk about it, or no one is around to talk to."

An estimated 3 million American seniors suffer from alcoholism or drug dependency, government reports show. The aging baby boomer population has experts planning for that number to triple by 2020.

But drinking and pill-popping aren't the only problem areas. Other behavioral addictions, such as hoarding and compulsive gambling, can pose equally dangerous risks to a senior's mental, physical and financial health, experts say.

The difference between the decline associated with old age and addictive behaviors is seen most in daily activities, says Dr. Christine Cauffield, a senior healthcare consultant in Sarasota.

The person will neglect personal hygiene, the house will be unkempt, and an addict will retreat socially, avoiding the phone or activities that used to be routine. He or she will choose to go to a casino, for example, instead of attending a family function.

"The distinction is when the behavior becomes a hazard to their daily life," Cauffield says.

The problem in part stems from the fact that aging decreases a person's tolerance to drugs and alcohol. Also, many seniors are living with and treating other health problems, from diabetes to heart disease, and those issues can aggravate a person's physical and mental well-being.

Intervention can be extremely difficult with older adults, often because family members and doctors didn't recognize the problem right away. Adult children often live out of town, or they're embarrassed thinking Mom or Dad might have a problem.

Hazlett says there is additional baggage for adult children, who may be accused of worrying about their inheritance. Worse, some may not deal with the addiction because they don't know where to get help, or can't afford it.

It's important that friends, family, doctors and neighbors look for warning signs unique to older men and women, Hazlett and other experts say. Here are some clues to watch out for, as well as strategies to address a possible addiction:

Alcoholism

Alcoholism is by far the most predominant addiction afflicting seniors, says Juan Harris, director of Independence Program for Older Adults at the Hanley Center in West Palm Beach. More than 85 percent of Hanley's older patients are being treated for alcoholism.

Older alcoholics drink to relieve mental and physical pain and often don't understand that tolerance weakens with age, Hazlett says. And like their younger counterparts, they will be preoccupied with drinking, in spite of adverse consequences.

Even more dangerous is when alcohol abuse mixes with psychoactive drugs, such as those that block pain. It's very common for older people to be prescribed multiple drugs, including those that affect the mind's chemistry.

Hazlett says 14 percent of all hip fractures to adults 60 and older are attributed to mixing prescription drugs and alcohol.

Warning signs include: Onset or continued behavior issues related to alcohol; increased sensitivity to alcohol effects; depression; drinking alone; alcohol hidden in closets, drawers

What to do: Focus on how behavior is affecting health. Include health care providers in treatment.

Prescription drug abuse

An estimated 85 percent of seniors take at least one prescription drug; 76 percent take more than one daily, says Larry Schonfeld, professor and chair of the department of Aging & Mental Health at the University of South Florida's Florida Mental Health Institute.

Risky situations emerge when older patients don't follow prescribed directions. Estimates show between 40 percent and 90 percent don't. Those who abuse are likely breaking the rules by ordering additional drugs online or stockpiling pill supplies.

"Prescription drug use starts out for legitimate reasons, but it gets out of control," Harris says.

Warning signs include: Abusing or misusing legitimate prescriptions, particularly narcotic pain killers; memory loss, stumbling; depression

What to do: Focus on how behavior is affecting health and involve physicians and family.

Compulsive Gambling

Seniors are targeted by the gaming industry because they have lots of time and, often, discretionary funds. Organized road trips to casinos and cruises are popular and, for many, a weekend at the slot machines is not a concern.

"We all start as social gamblers. We all start at the same place but don't know if we have an addiction," says Pat Fowler, executive director of the Florida Council on Compulsive Gambling.

Problems emerge when a person is spending inordinate amounts of time at casinos, bingo halls, horse or dog tracks, or Internet sweepstakes cafes that offer online gaming. Fowler says compulsive gamblers say the game alleviates pain better than any medication.

Senior gamblers who lose control risk losing a lifetime of savings, often at a point when they are unable to return to the workforce. Fowler says that places older addicts at an extreme risk for depression and suicide.

"Even if I lose $10 a week … that could be the difference between paying my electricity bill or not," she says.

Warning signs include: Gambling to 'calm nerves' or combat depression; sudden need for money or a loan; is uncomfortable or lies when asked about gambling; pawning or selling personal items

What to do: Resources and other support is available at Florida Council on Compulsive Gambling's toll-free, multilingual and confidential 24-hour line at (888) 236-4848 (ADMIT-IT).

Hoarding

As many as 1.2 million American adults suffer from a hoarding disorder. Many are older, as the condition, associated with dementia, increases in severity with age, Cauffield says.

Hoarders place intense emotional attachment on objects and are unable to discard anything. It can put a great strain on their physical space and increases the risk for falls and respiratory-related conditions. The situation also makes juggling a medical regimen difficult.

Half of all older hoarders suffer from mood and anxiety disorders such as depression. Their living situation can magnify that condition, creating shame, embarrassment and extreme isolation for the hoarder, Cauffield says.

Warning signs include: Emotional attachment to inanimate items bought while shopping; excessive and unsafe clutter; social isolation

What to do: Focus on safety hazards, not the mess. Never go through things or discard items when the person is not present.