Recognizing problems

From Chapter 1: Introduction in Improving our Response to Older Adults with Substance Use, Mental Health and Gambling Problems: A Guide for Supervisors, Managers and Clinical Staff

Signs of substance use, mental health and gambling problems often go unrecognized. Dementia and depression, in particular, are frequently not recognized. Signs may be ignored, attributed to the effects of aging (e.g., forgetfulness or confusion) or mistaken for signs of another problem (e.g., signs of depression, substance use problems and dementia may be similar). Symptoms of mental health problems in later life, such as anxiety and even psychosis (e.g., oddness, eccentricity or fearfulness), might be viewed as typical in an older person (“just a normal part of growing old”). Some people assume that older adults don’t have substance use or gambling problems, or think that few if any older adults drink or take other drugs at all; or they may believe that drinking is good for people in later life. They may consider gambling or drinking as pleasant, harmless activities that keep older adults from becoming lonely or bored. Not being aware that gambling can lead to serious problems and the absence of obvious signs of potential problems may contribute to a low rate of recognition of gambling problems (World Health Organization and World Psychiatric Association, 2002).

Older people may not be willing to discuss or admit their problems with substance use, mental health and gambling because they feel ashamed, or they believe that such issues should be dealt with privately. To hide the problem, they may isolate themselves. Some live in isolation for many years before a crisis—typically a problem with their health or housing situation—brings them to the attention of service providers.

Receiving help that specifically addresses problems at an early stage, before they escalate, may prevent the need for treatment and set people on a healthier course so that they can enjoy life, pursue interests and handle caregiving or other responsibilities. Interventions may be as simple as providing information to the older person to educate him or her on the issue. People with difficulties of a more intense nature may benefit from more formal interventions, such as brief counselling or a referral to a qualified specialist. Severe problems may require urgent medical attention. Understanding the condition and the older person’s history can help you to recognize the severity and to access the needed support.