This is the second of a two-part report on elder abuse and neglect, along with an outlook for future treatment considerations, heightens further awareness and engages providers in strategies to ameliorate this emerging epidemic.
Elder substance abuse is one of the irrefutable challenges created at the intersection of two health and social epidemics, substance abuse and elder abuse and neglect. This challenge is evolving and further developing as prescription drug use increases in the United States. With this increased use comes a rise in intentional abuse and unintentional misuse, especially among the elderly, as they are more likely to be taking prescription medications. Individuals 65 years and older account for one-third of all medications prescribed, which is disproportionate to the percentage of the population that they represent, approximately 15 percent of the population in the United States, according to the Basca–Community Prevention Initiative, 2008 and Population Reference Bureau, 2015.
Substance abuse among the elderly has emerged as one of the fastest growing health problems among the elderly for a host of reasons. Because an aging population has benefited from increased life-expectancy and, in large part, due to improvements in technology and healthcare delivery, more of them are abusing drugs and alcohol in their later years
The Hazelden Betty Ford Foundation reported in 2015 that nearly 35 million people in the United States are 65 years or older. Substance abuse among those 60 years and older (including misuse of prescription drugs) currently affects about 17 percent of this population. By 2020, the number of older adults with substance abuse problems is expected to double.
As demographics change, attitudes about and use of alcohol and drugs change as well. Baby boomers (those born between 1946 and 1964) have had more exposure to alcohol and illegal drugs, and there is more acceptance among them about using substances to ‘cure’ things. We expect to see an increase in drug and alcohol use; and more use means more problems, according to Frederic Blow, professor in the Department of Psychiatry at the University of Michigan and a Huss Research Chair on Older Adults and Alcohol/Drug Problems at Hazelden’s Butler Center for Research.
Blow said there has also been an attitude shift regarding addiction and treatment, and that gives him hope that older substance abusers will get the help they need. There is less shame and guilt associated with substance abuse now and more acceptance of treatment as a way to make things better.
Gender Specific Patterns
According to Michael Fletcher, MD, founder and medical director at iCAN (Integrated Chemical Addiction Network) in Crestview Hills, Kentucky, women are more likely than men to start drinking heavily later in life. Substance abuse is more prevalent among persons who suffer a number of losses, including death of loved ones, retirement, and loss of health. The fact that women are more likely to be widowed or divorced, to have experienced depression, and to have been prescribed psychoactive medications that increase the negative effects of alcohol help explain these gender differences. That said, Blow and other experts assert that as a whole, more older men have substance abuse problems than do older women.
Life Changes Drive Addiction
Basca reported that the life changes occurring as one reaches twilight years are significant. Elderly patients potentially experience a mixture of social-emotional, physical, and functional changes that may encourage addiction.
Frequently prescribed medications for misuse and abuse include opiates, central nervous system depressants, and stimulants due to their addictive qualities. Among the elderly the primary substances of abuse include benzodiazepines for anxiety and insomnia, pain relievers for arthritis and hip fractures, as well as alcohol, and over-the-counter (OTC) medications, all of which can have adverse reactions when mixed with other drugs or alcohol. Opiates. Opiates are very effective analgesics (pain relievers). They also create an intense sense of euphoria. The most commonly known prescription opiates are Vicodin and OxyContin, according to the Community Prevention Initiative, 2008.
Awareness, Education and Intervention
Unfortunately, healthcare providers often overlook substance abuse among older adults because they don’t know what to look for or they mistakenly assume that older adults cannot be successfully treated. Blow said that loved ones, too, may excuse an older relative’s substance abuse as a result of grief or loss or a reaction to boredom. Or family members may not want to confront an elder, fearing they will offend or anger them or get “written out of the will.”
Key stakeholders who need to be engaged in addressing the health and social epidemic of elder substance abuse include healthcare direct care providers. Social service agencies, community leaders and policy-makers, family members, and influential connections found in faith communities, A heightened awareness of the potential for elder substance abuse along with collaboration among these stakeholders can help ameliorate this issue through prevention and intervention strategies such as education, navigation through the maze of support programs and networks, and referral to chemical addiction treatment as appropriate.
-John Rudnick, Jr. is the Chief Operating Officer at Tri-State Gastro and Professor, Thomas More College—both located in Crestview Hills, Kentucky.