“There is a scarcity of information about alcohol use and the elderly,” said Marcos Antonio Lopes, corresponding author for the study and currently a visiting lecturer at Newcastle University in the United Kingdom, “which needs to be resolved in order to construct a real diagnosis and promote proper health care for this population.”

Jerson Laks, associate professor at the State University of Rio de Janeiro and a researcher with the Brazilian National Committee for Research, agrees. “Alcohol use is frequently an exclusion criterion for any study of cognition and dementia in the elderly, as well as in studies aimed at depression,” he said. “Therefore, by simply excluding alcohol use and abuse, most studies cannot reveal the interaction between drinking behaviors and cognition in this age range.”

The current study is also important, Laks added, because it did not have any expectations that the elderly would drink less than younger subjects and, furthermore, it asked many difficult questions despite their negative stigmas in order to uncover the facts about drinking among the elderly in Brazil and its association with dementia.

Lopes and his colleagues recruited a sample of 1,145 individuals who were 60 years of age and older (419 men, 726 women), from different socioeconomic levels, and examined them in two phases. The first phase used several instruments, including the CAGE questionnaire, a four-question screening test for alcohol dependence, to identify potential alcohol-related problems, as well as a screening test for dementia to identify cognitive and functional impairment.

The second phase used the Cambridge Mental Disorders of the Elderly Examination, as well as the Diagnostic and Statistical Manual of Mental Disorders—Fourth Edition, to establish a clinical diagnosis of dementia.

“We found that heavy alcohol use among the elderly people we investigated was high at 8.2 percent and affected principally men from low socioeconomic levels,” said Lopes. “However, the effects of heavy alcohol use on memory and other cognitive functions were more evident in women.” Lopes added that their finding of 8.2 percent was greater than expected, when compared to previous studies, but that the fundamental lack of information in this area of study makes comparisons difficult.

“This study shows that older people keep drinking along the life span,” said Laks. “Taking into consideration that drinking may lead to falls and to cognitive impairment when heavy use is the case, this study creates important awareness about this issue.”

The study was funded by the Fundação de Amparo à Pesquisa de São Paulo (FAPESP). This release is supported by the Addiction Technology Transfer Center Network.

This can be a tough subject to broach with your parents, particularly as they get on in years. But the truth is that as we age, we find ourselves with a variety of health problems, some minor, some serious, that may require a prescription medicine to cure, help alleviate symptoms, or just manage pain. These could be for heart-related concerns, arthritis, diabetes, problems with dental, vision or hearing. Prior to performing dental surgery, a dentist may prescribe an antibiotic. After minor or major surgery, the physician could prescribe a medication for temporary relief of pain and to stave off infection. Over time, medications seem to accumulate in the medicine cabinets of the elderly. Often times they don’t even remember what the medications are for. Mixing prescription medications, as well as over-the-counter (OTC) medicines, can be very dangerous – even deadly.

Each year, 30 percent of the prescriptions written in the U.S. are consumed by people over 65. According to recent census data, 35 million Americans are age 65 or older. This population spends more than $15 billion per year on prescription drugs. Substance abuse occurs in about 17 percent of the elderly. Most abuse occurs due to difficulty reading and understanding prescription instructions, overdoses, under doses, erratic dosing, use for nonmedical purposes, and use in combination with other drugs.

How, then, do you talk to your parents about the subject of prescription drug abuse? Here are some tips.

• Choose an Appropriate Time – You know your parents better than anyone else. When are they most receptive to conversation? Is it in the early or mid-morning? Are they more attuned to topics discussed in the afternoon or after dinner? Picking the right time to talk with them about their prescription drug use (and possible abuse) is critical. If you bring up the subject when they’re still half-asleep, or nodding off just before bedtime, you not only don’t have their full attention, but the discussion will possibly escalate into a full-blown argument.

• Visit for a Few Days – The best way to monitor the situation is to actually spend a few days with your elderly parents. This is especially recommended if you live out of state or far enough away that you don’t see them on a regular basis. Even if you do live nearby, recommend a visit to do some special things together, like attend a play or musical, go on a day trip, a museum, or whatever activities your parent(s) like to do. While you’re there, watch what medicines they take and when.

• Make a List – Many people leave their medicine containers right out on the counter, lined up in a row. It’s easy enough for you to make a list of everything that’s there – after they’ve gone to sleep. Don’t think of it as spying! The only way you’ll know what can possibly be interacting in a negative way is to have a complete list of all their prescribed medications. Jot down the names of all the physicians and contact numbers. The elderly are frequently prescribed medications for cardiovascular, central nervous system and musculoskeletal conditions. The most abused prescription drugs are the opiates or painkillers.

• Watch for Signs of Contraindications – Pay close attention to how your parent acts before and after taking medications. If you see evidence that they are drowsy, dizzy, have trouble with coordination, memory problems, difficulty concentrating, increased heart rate and pulse, or other symptoms, this could mean there’s something not right with their medications, or the combination of them or timing of taking them.

• Observe them Taking Medications — Watch as your parents take their dosages and, if appropriate, initiate the discussion then. Ask them, “Why are you taking this medicine after all this time?” You can also say, “I thought this was only for pain after your hip replacement, but that was three years ago. You should be done with this by now.” Tailor your questions and comments depending on what they say. If they’re agreeable, ask them if they have a list of all the medicines they take, and also ask them what OTC medicines they take regularly for any condition.

• Discuss Prescription Drug and OTC Interactions – Many times, elderly persons do not realize that what they are taking can prove harmful or even lethal. This is especially true if they have visited various doctors for a variety of conditions and were prescribed medications by each. Your parents may not know that different strengths or brands of medicines can cause adverse effects. They may not remember or recognize the onset of new symptoms or be able to distinguish between chronic and new conditions. Just having the discussion with them is a good first step to raise their level of awareness. You don’t have to get too technical. Just be knowledgeable enough that you can mention a few of the more prominent adverse interactions.

• Make Larger Labels – If your parents have difficulty reading the small print on the prescription medications, make larger-print labels (if their pharmacy is unable to do so). You could also make a list of medications, doses, times to take, etc., all in larger print. Laminate it and place it strategically so that it’s readily available to your parents.

• Consult with a Professional – You may wish to talk with a knowledgeable professional, a counselor, doctor, minister or social worker. Share with them your concerns. They will be able to look at the situation objectively and evaluate what options are available for your parents.

• Go With Your Parents to their Doctor – Make an appointment and go with your parent(s) to their doctor. Bring along the complete list of medications, OTC medicines, even herbs and vitamins that your parents take. Talk about any symptoms, problems, new or chronic, that you have seen or that your parents have shared with you. If there is any suspected prescription drug/OTC medicine and/or alcohol abuse, the doctor will recommend further action. What you really want to get to is to eliminate drugs that are no longer required, or to reduce dosage (while still at an effective level) for any medications that are absolutely necessary. Ask the doctor to clearly explain medications and OTC medicines that work against each others, or should never be taken together, as well as which medications should never be consumed with alcohol. The elderly place a great deal of confidence in what their doctor tells them, so if you haven’t had much luck convincing your parents that their drug use is hurting their health, this may do the trick.

• Treatment May Be Required – If the situation has progressed to the point of serious abuse, especially with older persons who have a cognitive impairment and who may also abuse alcohol, treatment may be required. This may involve a residential treatment program following detoxification. Insurance generally covers a good portion of this, and assistance is available through federal and state agencies. Hopefully, your parents won’t need this step, but there’s no shame in it if they do. Continuing therapy, counseling and group support meetings can provide lasting assistance to persons recovering from prescription drug abuse.