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Drug Addiction in the Elderly: An Overlooked Problem

There’s been a lot of focus on rising drug abuse problems in teens and younger adults but little has been said about the problems faced by elderly people who face these same addictions.

 

The fact that treatment is often focused at younger people causes the elderly to avoid treatment as much as the perception that drugs like those prescribed for pain aren’t really addictions or unsafe. Even those who do seek treatment face problems as elderly addicts are treated as lost causes and go almost entirely untreated.

Resolving drug addiction in this age group is made worse by the frail health state of elderly people and the pain levels that occur as a result. For many the problem begins in their younger years but terrible pain that doesn’t seem to respond well to even prescription pain relievers can results in a desperate search for relief too.

Many of the elderly have families that don’t see the problem, ignore it or mistake it for dementia rather than addiction. Growing older can be boring and depressing. Watching your loved ones pass on and not knowing what to do with your time can contribute to drug use to relieve stress and pass that time actively. It doesn’t take much to become addicted to it and makes it more likely that the addict will be that much less likely to give it up even if it has become a problem.

Elderly patients, who tend to take many medications prescribed by more than one doctor, are at risk for prescription drug abuse, the Miami Herald reports. The article notes health experts are concerned about the increase in the number of patients over age 50 that require intervention and treatment for addiction to medication and other substances.

 “There are physical, psychological and social factors that make elderly people more vulnerable to addiction,” Angela Conway of the South Miami Hospital’s Addiction Treatment Center, told the newspaper. She notes the elderly may become dependent on drugs prescribed to deal with joint pain, sleeping problems or injuries from falls. She adds sadness over losing loved ones, or being far from family, may also increase the risk of drug dependence.

 Nearly three in 10 people between ages 57 to 85 use at least five prescriptions, according to the Substance Abuse and Mental Health Services Administration (SAMHSA). Between 1997 and 2014, the rate of hospital admissions for conditions related to prescription medications and illicit drug use rose by 96 percent among people ages 65 and 84; for people 85 and older, admissions grew 87 percent. SAMHSA notes medication misuse and abuse can cause a range of harmful side effects, including drug-induced delirium and dementia.

 
Prescription and Proprietary Medications

 In contrast to alcohol abuse patterns, today’s elderly are more likely to encounter problems with prescription misuse than those in other age groups. About 80% of older adults have some chronic medical condition and the likelihood of multiple medical problems increases with advancing age.

The elderly receive from 25% to 30% of all prescriptions and use these drugs at a rate as much as two and a half times that of younger persons. Seniors also are heavier users of proprietary or over the counter medications. Multiple medical conditions, complex medication regimens, and the use of multiple care providers sets up a situation for high risk of adverse drug reactions.

 It is estimated that the elderly suffer two to five times the frequency of adverse drug reactions as occur among younger people, and some 10% of hospital admissions for seniors are due to such reactions.

 
Risk Factors:

 Prescribing practices are part of this problem. A recent report on a national study found that nearly one-quarter of the elderly are receiving prescription drugs whose use is contraindicated among that age group because of risks of adverse reactions. The elderly are particularly vulnerable to adverse reactions to psychotropic medications, a type of drug whose use is often not recommended for seniors or for prolonged periods because of risks of confusion, sleep disorders, falls, and misinterpretations of these symptoms as signs of senility.

 
Older adults are nonetheless estimated to receive many as 50% of the prescriptions for psychotropic medications. Older women, more likely to present symptoms of emotional distress to a doctor, are prescribed psychotropic medications at rates almost 160% higher than older men.
 

Miscommunication among providers and patients contributes to prospects of misuse, as does lack of coordination and follow-up of care. The older adult often has sensory and cognitive deficits that make understanding medication instructions difficult, but physicians typically spend less time with their older patients than with younger ones and are likely to provide them with less information about their medications.
 

According to the American Medical Association, the elderly themselves also play a role in medication misuse, failing to fully report symptoms and often underusing medications to avoid side effects or to save money, or using them in combination with alcohol, a situation that heightens the risk of adverse effects.

 Connections with community and voluntary organizations and churches are also important for reaching older adults. Finally, since many of the factors affecting risks for elderly substance abuse and misuse are based in social norms, patterns, and institutions, attention to these and to public policies may be needed as well.

 
Age-related Physiological Changes

  •  In general, increases in chronological age bring decreases in lean body mass, increases in the percentage of body fat, and decreases in absorption, distribution and disposition of alcohol, drugs and medications.
  • Age‐related physical changes serve to increase the effects of alcohol and other drugs on older people according to the U.S. Department of Health and Human Services.
  • The various physiological changes associated with aging have a significant impact on an older adult who uses or misuses alcohol or drugs, since these substances can have potentially harmful effects in older adults, even at low levels of consumption.
  • Age‐related pharmacokinetic and pharmacodynamic changes result in an increased sensitivity to alcohol, prescription drugs, over‐the‐counter drugs, and other substances in older adults.
  • Pharmacokinetics (the process by which drugs are absorbed, distributed, metabolized and eliminated by the body) changes with age and has a significant impact upon the efficacy of prescription drug use in the older person.
  • Prescription drugs may cause potentially adverse reactions in the individual if the physiological changes of aging are not considered.

 
Recommendations

 Recommendations for development of a substance abuse and misuse prevention program for this population includes the involvement in program design of senior services and other interested agencies and organizations as well as representatives of older adults themselves.

Strategies for consideration might involve the use of existing materials to compile a resource information package for widespread distribution, and education and training for the elderly, their families, and providers of other services and health care.

A focus on general health behaviors and support for secondary intervention and treatment as well as primary prevention is suggested, as are considerations of pilot projects to link information and education with more personalized follow-up.

 Finally, there needs to be support for policy initiatives to underscore these and other efforts to improve the health and well- being of older adults. Substance abuse and misuse among the elderly primarily involve illicit drugs, alcohol and prescription and over the counter drugs. These problems of abuse and misuse do not occur in isolation.

Later life is a time of many physiological and social changes. These changes may impact decisions to use or to stop using alcohol and other drugs. The balance of social forces in the lives of older adults can be important in understanding the use of substances, the motivation for treatment, and the support to foster recovery.

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