Is Your Client Really Senile
By: Amos Goodall, Jr.
Seniors suffer a variety of maladies that may look like senility or dementia - but aren't. Some can be reversed. Assuming seniors are beyond home can rob them and their family members. Identifying and trating these medical problems can actually restore competence and years of productice life. Trusts and estates professionals are in a unique position to help.
For some folks, drinking habits may continue without apparent problems throughout adulthood, but ultimately lead to conditions mimicking dementia or even Alzheimer's Disease in later life. Drinking habits that wouldn't be problematic for younger adults can cause serious harm as early as age 60. Even a small amount of alcohol can interact negatively with the medications that seniors often take. And the retired lifestyle can mask alcohol's cumulative toxic effects until it's too late.
Family members may be too close to notice critical changes or may believe these changes are a natural consequence of aging. Other observers, including over-worked physicians, may not be sensitive to the subleties of early alcohol degneration.
Traditional screening tools, both social and scientific, may not disclose hazardous alcohol use. A family and the person himself may assume dementia, delirium, mood disorder or personality problems are irreversible effects of aging when treatment could restore health.
Trust and estate professionals, who see clients on an infrequent but regular basis, may be best able to sound the alarm.
Physical responses to alcohol consumption change with aging. For example, stomach exzymes that help eliminate alcohol naturally decrease with age and alter the rate at which the kidneys eliminate alcohol. As a result, even a small amount of alcohol can have an unexpectedly large effect. It is a standard medical recommendation that adults over 60 years old limit their routine consumption of alcohol to one drink a day, allowing for up to two drinks on special occasions. These levels are somewhat lower for women.
Alcohol levels may need to be further restricted when a senior is taking prescription medications, which slows the rate at which even small amounts of alcohol and drugs leave the body. Benzodiazeprines, prescribed to treat sleep disturbances have long half-lives. Two of the most commonly prescribed, Temzaepam and Lorazepam, have a half-life of 10-20 hours; another, Quazepam, has a half-life of 25-41 hours, with long-acting active metabolites.
As trusts and estates professionals, we are not equipped to provide diagnoses of hazardous drinking. But we do have a duty to preserve the integrity of the estate plans we suggest and implement. And there are a variety of fairly simple screening tests that can help clients and their families identify and treat potential problems.
First, you can inform your clients and their families that the Department of Health and Human Services recommends every 60-year-old be screened for alcohol and prescription drug abuse as part of a regualr physical examination. This screening should be done more often when a client's medical condition or background suggest the possibilty of excess alcohol consumption.
Secondly, advisors can conduct, have professionals administer, or even ask clients to self-administer any of three establsihed tests, known by their acronyms: CAGE, MAST-G, and AUDIT. If these simple tests indicate a potential problem, advisors should suggest clients seek professional help, starting with their family physicians. Also appropriate: addictions counselors and psychologists specializing in addiction therapy.
CAGE consists of four simple questions, which are easily modified to screen for drugs. It is considered less effective for female drinkers than males. Although two or more positive responses indicate an alcohol problem, even one positive response should be grounds for further exploration (because denial is a symptom of alcoholism).
The CAGE questions are:
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Have you ever felt you should Cut down on your drinking?
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Have people Annoyed you by criticizing your drinking?
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Have you ever felt bad or Guilty about your drinking?
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Have you ever had a drink first thing in the morning to steady your nerves or get rid of a hang-over (Eye-opener)?
Another test, the The Michigan Alcohol Screen Test (MAST) has been modified for older adults. The MAST-G ("G" stands for geriatric) has a high sensitivity and specificity amoung adults in a variety of settings, including primary care clinics, nursing homes and living environments. A short (10-question) version and detailed discussion can be downloaded from http://www.hartfordign.org/publications/trythis/issue17.pdf.7 Advisors should consider keeping a copy of these tests on hand so clients can take them on their own or have them administered.
The Alcohol Use Dirsorders Identification Test (AUDIT), developed by the World Health Organization, also has 10 simple questions that should be failry easy to ask clients or which clients may ask themselves. Although not specifically designed for older adults, it has been validated cross cultrually. Because there are few culturally sensitive screening instruments, the AUDIT is recommended by the HHS as useful for identifying alcohol problems among older people who belong to ethnic minorities. The test is available on the website of Harvard University Faculty and Staff Assistance Program: http://atwork.harvard.edu/fsap/assessment/alcohol.shtml
Symptoms of hazardous drinking can mimic other, more irreversible conditions such as Alzheimer's Disease. While successful treatment for alcohol-related problems may no always stop deterioration of brain function, the absence of treatment certainly will lead in only one, sad direction. As advisors, we are well-situated to alert clients to the problem and make referrals to health professionals. We may be able to add years to our clients' lives and help them to return fromthe abyss.
**The endnotes have been taken out of this article