ORIGINAL RESEARCH

Lives of alcoholic older adults: contributions to gerontological nursing

Rejane de Fátima Parada Viegas^I; Janaina Moreno de Siqueira^II; Marilurde Donato^III; Maria Yvone Chaves Mauro^IV; Beatriz Gomes da Silva^V; Sheila Nascimento Pereira de Farias^VI

^I Master´s degree. Federal University of Rio de Janeiro. Anna Nery Nursing School. Rio de Janeiro (RJ), Brazil. E-mail: rejaneparada@gmail.com
^II Post-Graduate. Federal University of Rio de Janeiro, Anna Nery Nursing School. Rio de Janeiro (RJ), Brazil. E-mail: janaina.moreno@ymail.com
^III Ph.D. Federal University of Rio de Janeiro. Anna Nery Nursing School. Rio de Janeiro (RJ), Brazil. E-mail: marilurdedonato@terra.com.br
^IV Ph.D. University of Rio de Janeiro State. Nursing School UERJ. Rio de Janeiro (RJ), Brazil. E-mail: mycmauro@gmail.com
^V Specialist. Federal University of Rio de Janeiro, Anna Nery Nursing School. Rio de Janeiro (RJ), Brazil. E-mail: beatrizg.ufrj@gmail.com
^VI Ph.D. Federal University of Rio de Janeiro. Anna Nery Nursing School. Rio de Janeiro (RJ), Brazil. E-mail: sheilaguadagnini@gmail.com.br

DOI: http://dx.doi.org/10.12957/reuerj.2018.31376

ABSTRACT:

Objective: to identify the causes of abusive use of alcoholic beverages by the elderly. Method: in this qualitative study, the life history method was used to report the experiences of a sample of 22 older adults. Data were collected in 2007 and 2008 at a public hostel in Campo Grande and from three AA groups in Jacarepaguá, all neighborhoods of Rio de Janeiro City. The project was approved by the research ethics committee. The interviews were recorded in mp3 and, for data analysis purposes, the recordings of the testimonies were transcribed. Results: the category that emerged from the testimonies was: behind the scenes of alcoholism in old age; and the subcategories: the family as primary cause and social influence. Conclusion: there is a need to implement education and health policy providing for the prevention, treatment and rehabilitation of alcoholism, also among older adults, with a view to harm reduction and better quality of life.

Descriptors: Elderly; alcoholic; living experience; nursing.

INTRODUCTION

The global report on aging and health released by the World Health Organization (WHO) in 2015 highlights that healthy aging is more than just the absence of a disease. Maintaining functional ability is the most important thing for most of the older adults.

As a result, the greatest costs to society are not the expenses to promote this functional ability, but the benefits that could be lost if necessary adaptations and investments were not made. The recommended social approach to addressing population aging, which includes the goal of building a world that is supportive of older adults, requires a transformation of health systems that replaces disease-based curative models with integrated, needs-centered care¹.

Thus, with the growth of the elderly population², drastic changes must happen in health systems, so measures can be implemented that guarantee, support and encourage healthy longevity³. On the other hand, concomitantly with the increase of the elderly population, there is a culture of consumption of alcoholic beverages quite widespread.

In this sense, Brazil is in the 49^th place among the 193 countries evaluated by the Health and Alcohol Information Center (CISA), showing an increase in alcohol intake of 43.5% in 10 years, surpassing the average. Thus, disorders related to alcohol use in the country increased, accounting for 63% of emerging disorders, 60% of hepatic cirrhosis rates and 18.5% of traffic accidents⁴.

The World Health Organization (WHO), at the World Health Assembly in 2010, reached consensus on the need to develop a comprehensive strategy to address the problems generated by alcohol⁵. The abusive use of this substance is related to the death of 5.9% of people in the world⁶.

Based on this reality, the objective of the study was the abusive use of alcoholic beverages by older adults and the main guiding question was: what leads the older adult to become alcoholic?

Thus, the objective established was: to identify the causes of abusive use of alcoholic beverages by the older adults.

LITERATURE REVIEW

A relevant study by the Brazilian Institute of Geography and Statistics (IBGE) showed that the number of older adults grows and exceeds 30 million. These epidemiological data were registered from 2012 to 2017 and show that in Brazil, there was an increase in the elderly population in a greater proportion in the states of Rio de Janeiro and Porto Alegre, both with 18.6% of people in the age group of 60 years old or more⁷.

Also, a study conducted by CISA in 2018 showed that 27% of the elderly people interviewed consumed beer, 21% consumed distilled beverages and 35% drank frequently, being more prevalent in men than in women⁸. This statistic of increased alcohol intake by the elderly population corroborates another study conducted to evaluate the association between alcohol consumption and quality of life, where the prevalence of alcohol consumption was 8.9% in the age group from 70 to 79 years old, with the presence of depression⁹.

Another important paper was the report published in 2017 by the Syrian-Lebanese hospital on alcohol consumption in the elderly people. It states that alcoholism in this group is associated with retirement, loneliness, widowhood, social isolation and some chronic diseases¹⁰, corroborated by a study carried out in Paraíba, which states that the excessive use of alcohol in the elderly population is a consequence of the changes experienced mainly related to social aspects¹¹.

Finally, there is a greater risk of vulnerability to physical, psychological and social problems due to alcohol abuse by the elderly people, which are not always perceived by health professionals and, therefore, diseases are aggravated by alcoholism, with a major challenge for health services¹².

METHODOLOGY

This is a qualitative study carried out between the second semester of 2007 and the first semester of 2008. The method used was life story, in which the report the experience of the person is considered a source of the data, it is not up to the researcher to interfere, induce or question the story told¹³.

Two scenarios were chosen to show a diversity of experiences, understanding the phenomenon of the experience by each elderly person and considering the differences in the social context of each one. They are a Public Institution that houses street population in the neighborhood of Campo Grande and three groups of Alcoholics Anonymous (AA) in the neighborhood of Jacarepaguá, in the Municipality of Rio de Janeiro.

Elderly alcoholics of both genders were included in the study, with 10 residents of the public shelter and 12 attendees of Alcoholics Anonymous (AA) meetings. The inclusion criteria were to be over sixty years old, to be an alcoholic and to have the cognitive ability to answer the research question.

For the present research, two forms were used, one for the characterization of the deponents, containing sociodemographic variables (skin color, age, number of children, marital status, profession, education level, work situation, institution of origin, age when started drinking, (current consumption, current status of use of alcoholic beverage) and health (having hypertension or diabetes, and if they have suffered an accident after drinking alcohol); and another form with the following command to extract the data reported by the participants: Speak what you consider important about your life and related to abusive use of alcohol.

Two pilot interviews were conducted to verify the suitability of the command, the first one with a resident of the Shelter and the other one with AA participants. Before the interviews, the Free and Informed Consent Term (TCLE) provided for in Resolution 196/96 of the National Council for Research Ethics (CONEP), in force at the time of data collection was used for secrecy and anonymity. This document was signed by all those who decided to take part in the study and who were considered deponents. The letter I (interviewed) was used followed by the interview order number to preserve the anonymity of the deponents.

The interviews were recorded in MP3s under the justification of guaranteeing the reliability of what they said and at the moment of the analysis of the data the transcriptions of the recordings were transcribed. Each interview lasted, on average, ninety minutes, due to the difficulty of the elderly person in expressing. It is worth mentioning that before initiating them, each deponent was reiterated on the subject investigated, as well as on the contents of the TCLE.

All the participants' body expressions were recorded in the field diary during the interview, also recording what they did not say to avoid missing any details. From the registered testimonies, the content analysis was carried out emerging categories and subcategories that allowed the interpretation and understanding of the research theme.

RESULTS AND DISCUSSION

A low level of education was observed among the participants, where only one of them completed a higher level, four of them completed the high school and the others had lower education, five of whom were illiterate.

Also, ten of the sample were retired, eight still worked to supplement the income, being a pensioner.

Regarding the approximate time of alcohol consumption, nine began drinking in childhood, six in adolescence, five in adulthood and only two did not know to inform.

As for the chronic diseases, seven participants said to be hypertensive and three diabetics, being excessive alcohol use a possible aggravating of the health situation of these individuals culminating in the appearance of these morbidities.

The age group ranged from 60 to 78 years old, in which thirteen were 60 to 70 years old and nine were 71 years old or more.

Fifteen of the twenty-two deponents were white, four were brown and two were black.

Regarding the number of children, sixteen older adults said they had one to five children, five reported having no children and only one reported having six children. Seven of the deponents reported being married, seven separated, four unmarried, two divorced and two widowed. Those who reported that they had never married were residents of the public shelter, originating from unstructured families, marked by violence, misery, hunger, ill-treatment and, according to their reports, they resided in other states, but escaped from their homes as a teenager to earn their livelihood in the city of Rio de Janeiro, without success.

Both lifelong difficulties and discriminatory relationships were self-reported by the elderly participants as triggering excessive alcohol use.

Study category and subcategories

From the category: The backstage of alcoholism in old age appeared the subcategories analyzed below.

Subcategory 1: family as the primary cause

Twelve of the twenty-two deponents were members of AA and the other ten were residents of a public shelter. In the first case, everyone had a family who supported them; in the second case, they were indigent, some even attending AA meetings.

Family disruption such as separated fathers, conflicts in the home, a lot of permissiveness, maltreatment, absence of religion, and living with relatives who use drugs (addicts) or who consume excessive alcohol are among the factors of excessive alcohol consumption¹⁴.

The abusive use of alcohol facilitates the fragmentation of the family since it is sometimes associated with violence and mistreatment, which may lead to the separation of a family¹⁵.

In the I18 report, a chronic stress on drinking, an acute stressful situation led to alcoholism. Among the purposes for the use of the alcoholic beverage, individuals sometimes take it to escape the reality of their lives, trying to mask periods of intense suffering with the drink, for the excitatory properties of the alcohol that initially provides a sensation of pleasure and euphoria¹⁶.

Analyzing this speech, it is possible to observe how the deponent demonstrated her disapproval for seeing her reference to a failed, dominated, unsuccessful woman, noting that when she did something wrong, her father ordered, as punishment, that her mother beat her legs with electric iron wire. His brothers, though much older, were dominated by his father, and no one besides her was able to oppose him.

The family is our main socializing point. Through it, we have the first contact with people and it can positively or negatively influence their members. In the above reports, we can see how the parents' behavior reflected in the mental, physical and financial health of the home, contributing to their children becoming alcoholics in the future¹⁷.

Some of the reasons that lead the individual to drink is the family environment as one of the factors that favor alcohol consumption, along with the benefits that alcohol brings in the socialization and interaction in the workplace¹⁸.

Subcategory 2: The influence of society

The need for socialization increases the prevalence of alcohol intake, and it is important to consider sociodemographic factors so policies and prevention programs can be implemented⁹.

Here we consider the conviviality of the elderly person with people who drank in any environment and the factors that influenced the consumption of beverages.

The testimony shows that the individual constructs values ​​based on what his group represents. Thus, his identity is projected in cultural practices that lead him to acquire a certain image in society. Many individuals begin to reproduce the habits of a group to preserve their participation in social life so they do not feel alone. Others, to avoid jokes of the group for not reproducing something that is accepted, encouraged and practiced by the people of the conviviality, being almost a condition for acceptance of the individual in society.

Individual behavior can influence their peers in a complex way, tending to perpetuate the habit of drinking throughout a group, and it is more difficult to resist when one tries to change their pattern of consumption and habit¹⁹.

A study carried out in the city of Rio de Janeiro on motivation to drink showed that eight of 21 interviewees are influenced by friends to consume alcohol. Regarding the purpose, five of them said that they drink to accompany a friend, as alcohol being an integration facilitator social²⁰.

In this study, many deponents reported avoiding going to parties or places that serve alcoholic beverages, and even the company of people who had a habit of drinking, to escape the influence that the environment and people have on alcohol consumption as reported below:

The following testimony shows social culture also influencing the habit of drinking since the deponent has developed the habit of drinking alcoholic beverages because of family and cultural issues.

Individual experiences are sometimes the result of practices developed by their groups. The habits and historical-cultural habits of certain groups and/or regions ensure, in a certain way, the propagation of the memory of their practices, which leads to the replication by the people inserted in this conviviality. Thus, the act of ingesting alcohol has a strong relationship with the beliefs of convivial groups, especially the family. In some cultures, alcohol is seen as a remedy capable of whetting appetite, so from an early age, the individual learns from the mother and family about the practice of this act before feeding. Thus, over the years, this becomes a habit as something almost intrinsic to the routine of the individual who propagates it to future generations. Other people use alcohol in ceremonies, such as birth, marriage, and death, sometimes leading to drunkenness.

Health education for certain groups can be a challenge. However, working with harm reduction, considering the individual's way of life and their knowledge and practices, can be the way to build consumption patterns with less health problems²¹.

CONCLUSION

As a conclusion, some very relevant points of the study can be identified.

The first idea is that most of the deponents started to drink in childhood or adolescence. In this way, there is a need to qualify professionals in schools for the detection of harmful use of alcohol by children and subsequent referral to the competent bodies. Also, it is also necessary to enable health professionals to identify alcoholism, at the time of the consultation, as a background for the aggravation of chronic diseases, since the elderly people do not seek health services to treat alcoholism.

Another important point is the implementation of policies to provide adequate shelter for elderly alcoholics in community centers and public institutions and refer them to treatment and rehabilitation centers whenever necessary, enabling them to experience old age in well-being.

Also, instituting education and health policies for the prevention, treatment and rehabilitation of alcoholism, reducing harm and improving the quality of life for those who abuse alcohol and carry cultural and family significance in alcohol consumption, may favor acceptance of changes in habits by this group, where the team must always use active listening and the construction of health education based on the reality of the group.

However, as a limitation of the study, the study was carried out on three anonymous alcoholics and a public shelter, which could be expanded to other anonymous institutions and/or alcoholics to obtain more diversified information to better understand the alcoholism/elderly reaction.

Finally, considering all the aspects addressed in this article, it is recommended the production of future studies that seek to better understand the experience of older alcoholics for more effective treatment.

REFERENCES

1.World Health Organization. Aging and health report. Genebra: OMS; 2015.

2.Silva DM, Vilela ABA, Oliveira DC, Alves MR. The structure of family social representation for elderly people living in intergenerational homes. Rev. enferm. UERJ. 2015; 23(1):21-6.

3.Borges CL, Silva MJ, Clares JWB, Nogueira JM, Freitas MC. Sociodemographic and clinical characteristics of institutionalized elderly: contributions to nursing care. Rev. enferm. UERJ. 2015; 23(3):381-7.

4.Center for Health and Alcohol Information. Epidemiological data on alcohol use in Brazil. São Paulo: CISA; 2014.

5.World Health Organization Manual of Interventions for mental, neurological and alcohol and other drug disorders in the basic health care network. Genebra: WHO; 2010.

6.World Health Organization. Global strategy to reduce harmful use of alcohol. Genebra: WHO; 2012.

7.Ministry of Planning, Budget, and Management (BR), Brazilian Institute of Geography and Statistics. IBGE Agency. News. Number of elderly grows 18% in 5 years and exceeds 30 million in 2017. Rio de Janeiro: IBGE; 2018.

8.Center for Health and Alcohol Information. Profile of alcohol consumption by Brazilian elderly and factors. São Paulo: CISA; c2018.

9.Soares SM, Lima EDRP, Naegle MA, Silva PAB, Santos JFG, Silva LB. Alcohol consumption and quality of life in the elderly in family health. R. enferm. Cent.-Oeste Min. 2016; 6(3): 2362-76.

10.Hanna C. Your health. Alcohol consumption among elderly increases. São Paulo: Hospital Sírio-Libanês; 2017.

11.Costa IP, Oliveira FKS, Pimenta CJL, Almeida MR, Moraes JCO, Costa SP. Ministry of Planning, Budget, and Management (BR), Brazilian Institute of Geography and Statistics. IBGE Agency. News. Number of elderly grows 18% in 5 years and exceeds 30 million in 2017. Aspects Related to alcohol abuse and dependence by the elderly. Rev. enferm. UFPE online. 2017; 11(6):2323-8.

12.Kano MY, Santos MA, Pillon SC. Alcohol use in the elderly: cross-cultural validation of the Michigan Alcoholism Screening Test - Geriatric Version (MAST-G). Esc. Enferm. USP. 2014;48(4):648-55.

13.Bertaux D. Life narratives: the research and its methods. São Paulo: Paulus; 2010.

14.Matos AM, Carvalho RC, Costa MCO, Gomes KEPS, Santos LM. Frequent consumption of alcoholic beverages by school adolescents: study of associated factors. Rev. bras. epidemiol. 2010; 13(2): 302-13.

15.Teixeira EP, Hoepers NJ, Correa SM, Dagostin VS, Soratto MT. The family's confrontation with alcoholism. Revista saúde.com. 2015; 11(3):213-26.

16.Martins KD. Alcohol Dependence on the Dialectic of Aging. Rev. Cocar. 2014; 8(16):137-49.

17. Center for Health and Alcohol Information. Social problems from the use of alcohol. São Paulo: CISA; 2014.

18.Buss PM. Health promotion and quality of life. Ciênc. saúde coletiva (Online). 2000; 5(1):163-77.

19. Center for Health and Alcohol Information. The influence of friends on alcohol consumption. São Paulo: CISA; 2014.

20.Neves KC, Teixeira MLO, Ferreira MA. Factors and motivation for alcohol consumption in adolescence. Esc. Anna Nery Rev. Enferm. 2015; 19(2):286-91.

21.Bertoni LM. Alcoholism and rural environment. Rev. GeoNordeste. 2017; 28(1):98-113.