Angela G. Gentile, MSW, RSW
People with dementia who are also experiencing alcoholism or alcohol abuse is a very challenging situation for family members to manage. Alcoholism speeds the decline in the skills needed for independent living, worsens behavioural problems, and raises concerns of safety for the affected family member and those living with/caring for them. This is in addition to the known health risks of alcoholism (e.g., cirrhosis of the liver, alcohol withdrawal syndrome and death).
Statistics reveal that 40% of adults 65 and over drink alcohol. We also know that almost 15% of older adults have Alzheimer’s disease or another form of dementia. The issues surrounding dementia and alcohol are becoming more prevalent as our society ages. We need to work together to find solutions to manage this difficult situation.
For families who are caring for a loved one with dementia such as Alzheimer’s, alcohol use becomes extremely challenging. The person is already impaired cognitively (in thinking, memory and processing information) and adding alcohol to the situation makes it much worse. A person with memory impairment may not appreciate how much s/he is drinking and will often neglect nourishment and basic hydration. It is even harder for family members to keep on top of things when the loved one lives independently. I have seen this problem in many settings such as when the person lives alone, or with family members, or in long-term care.
Family members ask what can be done. There are a few things that can be tried; however, there is not a clear-cut answer. I would like to share with you some of the common problems and solutions related to drinking and dementia.
• A person who consumes a lot of alcohol on a regular basis may start to neglect his or her own hygiene and health care. Self-neglect is often the first sign that alerts family members that something is not right.
• Certain medications and alcohol do not mix. For example, a sleeping pill taken with alcohol can cause increased confusion. Be aware of over-the-counter sleep aides that often contain diphenhydramine (e.g., Benadryl).
• The person with dementia is already impaired — becoming intoxicated makes matters worse. Increased confusion, risky behaviour and falls can cause complications. Falling can cause bruises, cuts, sprains and fractures and can lead to hospitalization.
• Against his or her better judgement, an intoxicated person may decide to go for a drive. Remove the keys or disable the car if this poses a potential risk.
• If the person lives in a rental suite, s/he may face risk of eviction. If the person neglects to care for the home environment and/or him or herself, co-tenants may complain of fruit flies, rodents or odours (like urine due to mismanaged incontinence). Other tenants may not like the fact there are risks associated with the person smoking (fire hazard). The person with alcohol dependence may not pay the utility bills, or fail to pay rent. These are all grounds for eviction if the situation is not rectified.
• Some people develop life-threatening illnesses related to drinking, such as cirrhosis of the liver. They are told they should stop drinking, but forget that they were told. They may need to be in a 24-hour secured facility to keep them healthy and alcohol-free. This is only when deemed incompetent or incapable of understanding the risks.
• People with dementia and/or alcoholism may confabulate. This is when a person unintentionally lies about the facts. They appear to be telling the truth, but in fact, it is all made up. This makes it difficult for family members to trust their loved one and get a true sense of what is going on.
• Nutritional deficiencies can occur in people who have alcoholism. They tend to drink a lot of alcohol, but usually don’t eat enough foods containing thiamine, or vitamin B1. Thiamine is naturally found in fruits and vegetables. This continues to cause damage to the brain and body (Wernicke-Korsakoff Syndrome) which may be irreversible.
Practical Tips for Helping a Loved One with Dementia Stay Safe:
• Remove all alcohol from the home. If necessary, replace it with non-alcoholic beverages such as low-alcohol or non-alcoholic beer or wine.
• Put the person’s address on the “Do Not Deliver” bottle delivery list. Some bottle delivery programs will accept a letter from a doctor or another person in authority, such as the person assigned Durable Power of Attorney. Call your local liquor commission to inquire about this option.
• Let all other family members and friends know that you would like them to refrain from bringing alcohol to the person.
• Keep the person busy with other activities.
• Find out what is motivating the person to drink. Could it be loneliness, stress, anxiety, depression or grieving? Find solutions to these underlying causes.
• If possible, limit access to funds they use to pay for the alcohol.
• Contact your local addictions organization for more support. Join an Al-Anon Peer or Family Group.
• Know your limits as a family member/caregiver. Look after yourself first. The overuse of alcohol likely predated the dementia and will likely be a difficult behaviour to change. A loved one with dementia is unable to appreciate (or remember appreciating) that there is a problem.
• Get your loved one assessed by a specialist. Geriatric Psychiatrists are experienced in this area. It is difficult to determine the level of cognitive impairment when someone is under the influence.
• Enlist the help and support from other family members and friends.
• Consider Family Counselling to work on the issues together.
• Pursue individual psychotherapy if you are feeling guilty, struggling with the change in roles, or grieving the loss of your loved one.
• Contact your local Alzheimer’s organization for more support and tips.
• Detoxification and rehabilitation are difficult and usually impossible for persons who have irreversible brain damage from chronic alcoholism. I have seen situations where the person is hospitalized, detoxed (removing toxins and abstaining from alcohol), then move to a secured facility for older adults which offers either no access to, or controlled access to alcohol. Voluntary recovery is almost impossible in persons with dementia. A person needs certain mental abilities to benefit from rehabilitation (restoring to optimal health and functioning). Most programs are based on cognitive-behavioural changes, which is not possible for someone with mid to late-stage dementia. A person with mild or early stages of dementia may be able to benefit.
• I have seen success in persons who have dementia and whose lives were derailed by alcoholism when they are detoxed in hospital, then moved to a supportive environment where there is no access to alcohol. They benefit from living in a secured environment where they have stimulation, supervision and activities. They thrive with regularly scheduled meals, medications, and personal care assistance. In my community, these facilities are called Supportive Housing or Personal Care Homes (also known as Nursing Homes.) One unfortunate (or fortunate?) side-effect of this is that the person thrives and does so well that he or she may get to the point where it appears that s/he will be safe and capable of living independently. We fear that once the person moves out and lives independently, they will start drinking again. With proper supports and increased diligence (although the person may not see a need for it) it is possible for them to move home.
Families can encourage older adults to ensure that Power of Attorney, Wills and a Living Will/Advanced Health Care Directive is prepared well ahead of time. This will help prevent any major problems down the road — for example, when it comes time to sell property.
If you or someone you know has an addiction to alcohol, seek medical advice or call your local addictions organization. Education and support are key to aid in prevention and treatment of this challenging situation.
Angela G. Gentile, M.S.W., R.S.W. is an author and specialist in aging with more than 25 years of experience working with older adults and their families in a variety of capacities. She has written a book called “Caring for a Husband with Dementia: The Ultimate Survival Guide” and a mobile app for iOS called “Dementia Caregivers Solutions.” When she’s not working, she enjoys writing, traveling, photography and exploring what it means to age well. She is a realistic optimist who lives in Winnipeg, Manitoba with her husband and two children. Find her online at angelaggentile.com.
Photo credit: “Dandelion Wine” by Sattva @ FreeDigitalPhotos.net