id 31376

ORIGINAL RESEARCH

 

Lives of alcoholic older adults: contributions to gerontological nursing

 

Rejane de Fátima Parada ViegasI; Janaina Moreno de SiqueiraII; Marilurde DonatoIII; Maria Yvone Chaves MauroIV; Beatriz Gomes da SilvaV; Sheila Nascimento Pereira de FariasVI

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 49th 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.

My father, as I said at the beginning, was separated, my father disappeared, he had no responsibility [...], today I know he was alcoholic, he drank a lot [...], he forgets to work too [...] ] I have an older son and a twenty-year-old son who have also this disease [...]. (I1)

[...] I was always going to get a drink there for my mother, who liked to drink hidden from my father [...]. (I16)

[...] it was 78, I was helping neighbors [...] when they came to warn me: Oh! Run that your father killed your mother! [...] when I got there, the ground was full of blood [...] then we went to the bar, he was all bloody, drinking [...] from that day I started drink straight. (I18)

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.

I started drinking when I was ten. My mother was washing clothes out there and asking me to buy a drink... I put the drink under the tank [...] when she went to the kitchen, I drank [...]. (I18).

I became alcoholic because my father was a dictator, I had a quarrel with him [...] I never saw him fighting with my mother, nor could I, because my mother was more submissive, disgusting [...] I was angry because he ruled all my brothers, [...] I wanted to be the savior (I9).

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.

[...] I went to work in an environment where all people drank [...] they had the habit of drinking at lunchtime... and I, to integrate myself, to be part that way... I then started drinking outside of business hours [...] to analyze the day. (I14)

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:

I remember that I began to work and to live with people in the factory, who also had problems of alcoholism. They were Homeric parties... I avoided going to parties, going to meetings of some families, my sisters' friends, my sisters also had this habit of liking to drink, so I was in the middle [...]. (I14)

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.

[...] I was born and raised in a place where drink, wine, and beer were all part of the diet... I was raised with it [...]. (I4)

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.

 

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