Guide to Addiction Prevention for Seniors
When discussing substance abuse and addiction, most people think about teenagers and young adults. Much public education is devoted to addiction prevention beginning in the elementary years, as evidence has shown that early education and intervention reduces the likelihood that children will experiment with drugs. Most people would be surprised to learn that substance abuse and addiction is actually a growing problem among senior citizens.
This guide contains more than 50 valuable resources from high-quality sources such as government and education sites, leading professional journals, organizations devoted to substance abuse and addiction awareness and treatment, and other informative and reputable sources.
Table of Contents:
- Lack of Adequate Training for Substance Abuse and Addiction in Seniors
- Substance Abuse and Addiction are Already Common in the Elderly
- Substance Abuse is Often Overlooked in the Senior Population
- Drivers of Abuse Behaviors Differ from Young Adults
- Substance Abuse is More Dangerous for Seniors
- Addiction Detection by Loved Ones
- If you Suspect Drug Abuse: Interventions for Seniors
- Rehabilitation Dangers for Seniors
Lack of Adequate Training for Substance Abuse and Addiction in Seniors
Because of this widespread misconception, most caregivers and family members of the elderly don’t even consider substance abuse as a possibility. But it’s actually a problem that’s likely to become even more prevalent in the coming years. According to a report from the Institute of Medicine, however, “Current education and training for most health care providers do not cover the skills and competencies necessary to provide adequate care for older adults who need MH/SU care.” In other words, we’re unprepared.
Richard A. Friedman, M.D., explains in an article for The New Old Age Blog that this trend shouldn’t be surprising when considered in the broader context of our aging society. The Baby Boomers, currently entering their senior years, grew up in the ‘60s and ‘70s, making them far more likely to have experimented with illicit drugs than the generations before them.
Here are 7 excellent resources on substance abuse in seniors, identification and treatment:
- The Growing Problem of Illicit Substance Abuse in the Elderly: A Review
- Substance Use and Abuse Among Older Adults [PDF]
- Barriers To Identifying And Treating Older Adults With Substance Abuse Problems
- Seniors and Drugs
- Substance Abuse in Senior Citizens – A Serious Problem
- Nursing Standard of Practice Protocol: Substance Misuse and Alcohol Use Disorders
- Drug Facts: Nationwide Trends [PDF]
Substance Abuse and Addiction are Already Common in the Elderly
Substance abuse and mental health disorders aren’t exactly uncommon among the elderly population as it is. Data from 2010 suggests that between 14 and 20 percent of the elderly population have one or more substance abuse or mental health disorders, which equates to approximately 6 to 8 million older Americans.
In 2010, there were 40 million Americans age 65 and older, a number which is expected to increase to 73 million by 2030. Additionally, Friedman points out that the rates of illicit drug use among adults aged 50 to 59 increased from 2.7 percent to 6.3 percent between 2002 and 2011, according to research from the Substance Abuse and Mental Health Services Administration.
Check out these 7 resources for more statistics and research on drug abuse and addiction in the elderly:
- Substance Abuse in the Elderly [PDF]
- Substance Use by Older Adults: Estimates of Future Impact on the Treatment System
- Prescription Opioid Abuse in the Elderly an Urgent Concern
- Changing Substance Abuse Patterns among Older Admissions: 1992 and 2008 [PDF]
- Epidemiology of Alcohol and Drug Use in the Elderly
- Illicit Drug Use Among Older Adults [PDF]
- Baby boomers: The hooked generation?
Substance Abuse is Often Overlooked in the Senior Population
Substance abuse and addiction exist in the elderly population, but it’s not something family members, caregivers, physicians and other people typically think about. If they do think about it, they may not be comfortable asking about it.
In older adults, even moderate substance abuse can be dangerous. Older people often metabolize foods and substances at different rates, making it easier to accumulate dangerously high concentrations of drugs and alcohol. The brain may handle substances differently in older age than it did in a person’s 20’s or 30’s.
Older adults are often taking multiple prescription medications, which can lead to dangerous drug interactions, particularly if the medications are not all obtained from the same physician or pharmacist. According to the Substance Abuse and Mental Health Services Administration (SAMHSA), 3 out of 10 adults between the ages of 57 and 85 use five prescription medications or more.
The following 5 resources offer insight into trends and perceptions leading to the under-recognized but growing problem of addiction in the elderly:
- Addiction in the elderly – an underestimated diagnosis in clinical practice?
- Geriatric Substance Abuse [PDF]
- Elderly drug and alcohol abuse often undetected
- Drug and alcohol referrals: are elderly substance abuse diagnoses and referrals being missed?
- The Changing Face of Older Adult Substance Abuse
Drivers of Abuse Behaviors Differ from Young Adults
The elderly aren’t typically motivated by the same factors that influence teens and young adults to use drugs. Seniors are more likely to abuse alcohol and use prescription medications inappropriately than they are to abuse illegal substances, and they usually don’t do so to seek a “high” or thrill. Instead, the elderly are usually driven by a need or desire to manage physical or psychological symptoms – so they’ll take sleeping pills, anti-anxiety medications and prescription pain medications to do so.
There’s another scenario that occurs among the elderly, as well. If a senior citizen becomes injured or disabled, requiring surgery or suffering from chronic pain, a physician won’t hesitate to prescribe prescription opiates to help manage pain. But with long-term use, even patients who take opiates as prescribed develop a physical addiction to the drug, and stopping the medication suddenly can result in unpleasant withdrawal effects.
Other possible drivers of substance abuse in seniors includes:
- Grief from death of a spouse
- Difficult divorce
- Loss of employment
- Mal-adjustment to major life changes, such as retirement
- Cultural experiences that have led to more relaxed attitudes
- Chronic pain, such as arthritis
- Recovering from major surgery, such as a hip replacement
- History of substance abuse
The other problem with opiates is that the body develops a tolerance, meaning a higher dose is required to achieve the same effects. Even if a senior’s intent is to reduce pain to a manageable level, eventually a higher dose will be required in a chronic pain situation.
These 7 resources discuss situational and emotional factors that place seniors at increased risk of substance abuse:
- Improper Use of Medications
- Risk Factors for Misuse And Abuse of Psychoactive Drugs
- Substance Abuse and Misuse in Older Adults
- Elderly at Risk for Prescription Drug Abuse
- The Epidemiology of At-Risk and Binge Drinking Among Middle-Aged and Elderly Community Adults: National Survey on Drug Use and Health
- At Risk Populations – The Elderly
Substance Abuse is More Dangerous for Seniors
Abusing drugs or alcohol is dangerous for an individual at any age, but the elderly population is at greater risk for certain complications and adverse events due to physiological changes that occur with aging. According to the American Society of Addiction Medicine (ASAM), the elderly, cachectic or debilitated patients are more likely to experience respiratory depression and constipation.
According to DrugFree.org (citing research from SAMHSA), “Between 1997 and 2008, 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.” Elderly patients who misuse or abuse their prescribed medications are increasing their risk of dangerous side effects, such as drug-induced delirium or dementia, SAMHSA points out. Yet the non-medical use of prescription medications continues to rise in the older adult population.
The signs and symptoms of substance abuse can be easily confused with symptoms of comorbid conditions. Family members, for instance, may assume symptoms such as memory loss are resulting from progression of Alzheimer’s disease, when in actuality they’re being caused by misuse of medications or adverse drug interactions.
Potential risks of drug or alcohol abuse and/or addiction for seniors:
- Increased sensitivity or decreased tolerance (less substance produces stronger effect)
- Higher blood concentrations due to slow metabolism
- Risk of accidents, falls or injuries
- Excessive daytime drowsiness
- Disorientation or delirium
- Significant memory problems
- Slowed respiration
- Worsening liver disease, cardiovascular disease, or diabetes
- Sleep disruptions or disorders
- Ulcers and gastrointestinal problems
- Adverse drug interactions resulting in seizure, coma or death
When prescribing opioids to elderly patients, physicians often start at one-third to one-half the typical dose. Elderly patients should also be more closely monitored through the course of treatment. But physicians alone cannot monitor patients continuously, so caregivers and family members must also pay close attention and watch for potential signs of abuse or dangerous side effects.
These 7 resources discuss the potential dangers associated with misuse of prescription drugs and substance abuse in the senior population:
- Substance Abuse and Misuse Among Older Adults
- Substance Abuse in Aging and Elderly Adults: New Issues for Psychiatrists
- Alcohol Addiction Among the Elderly
- Geriatric Substance Abuse [PDF]
- Drug Use In The Elderly: Risk or Protection?
- Drug and Substance Abuse
- Substance Abuse in Aging and Elderly Adults
Addiction Detection by Loved Ones
Elderly patients are often reluctant to seek help out of fear of losing independence. It’s not uncommon for seniors to hide problems, such as difficulty ambulating or frequent falls, from loved ones to avoid becoming a burden. They may be embarrassed or ashamed to admit they have a substance abuse problem, or they may be in denial, refusing to consider the idea that a substance abuse problem exists.
Likewise, addicted persons are unlikely to willingly and intentionally seek out help without intervention, so the odds of a senior citizen with an addiction problem self-identifying and seeking treatment are slim.
Family members may notice warning signs but brush them off as typical symptoms of aging. That’s why it’s important to be aware of the potential for drug abuse in the senior population and pay close attention to potential warning signs.
Some warning signs of substance abuse in the elderly include:
- Weight loss and/or decreased appetite
- Memory loss
- Agitation or irritability; short temper not typical of the individual
- Mood swings, unusual sadness or depression
- Sudden increase in anxiety
- Difficulty concentrating or paying attention
- Complaints of insomnia
- Difficulty making decisions
- Hiding or lying about drinking habits
- Signs of withdrawal, such as tremors
- Hiding alcohol or pills
- Forgetfulness or blackouts
- Social withdrawal; lack of desire to participate in usually enjoyable activities
- Discomfort or embarrassment when asked about substance use
Check out these 5 resources to learn more about the warning signs and risk factors for elderly substance abuse:
- Substance Abuse Among Older Adults
- Risk Factors for Alcohol Abuse
- Recognizing Substance Abuse
- Warning Signs of Prescription Drug Abuse in the Elderly
- Signs of Prescription Addiction Among the Elderly
If you Suspect Drug Abuse: Interventions for Seniors
Discussing sensitive issues with an aging loved one, particularly a parent, can be uncomfortable. Many adult children put off the task of talking with their aging parents about advance care planning, driving safety concerns and similar issues as long as possible. But like many of these other sensitive issues, substance abuse in the elderly poses serious risks – too serious to be ignored.
But healthcare providers only see their patients on a limited basis, so it’s easy for seniors to mask an addiction problem in the outpatient clinical setting. Often, it’s a concerned family member or caregiver who alerts healthcare providers of a potential problem.
These 5 resources offer information on initiating discussions with aging loved ones when you suspect substance abuse and other ways to seek help:
- Alcohol use disorders in elderly people: fact or fiction?
- Addiction in Older Adults
- Substance Abuse in Older Adults
- Holding an Intervention for an Older or Elderly Addict
- Drug or Alcohol Intervention for Your Elderly Loved Ones
Prevention and Awareness Resources on Addiction Prevention for Seniors
As with any age group, prevention of addiction among seniors is the best solution for the growing epidemic. “Older patients are more likely to be prescribed long-term and multiple prescriptions, and some experience cognitive decline, which could lead to improper use of medications,” according to a report from DrugAbuse.gov.
For this reason, family members and/or caregivers should be carefully monitoring medication management for aging adults. Keeping the home free of expired medications and prescriptions that are no longer being used helps prevent accidental drug interactions and improper dosing.
Tools such as medication dispensers enable caregivers to sort multiple medications into individual containers for morning, afternoon and evening doses to simplify complex regimens for aging adults. Being involved with medication management makes it easier to detect potential patterns of abuse before they become a much larger problem. If you’re dispensing the medication, for example, it’s easy to detect missing painkillers and other medications, indicating that your elderly loved one may be taking additional doses to try to self-manage symptoms.
For more information on prevention strategies and substance abuse awareness, check out the following 6 resources:
- Prevention Tactics: The Elderly and Prescription Drug Misuse and Abuse [PDF]
- Elderly Alcohol and Substance Abuse
- Prescription Medication Misuse and Abuse Among Older Adults [PDF]
- Preventing Substance Abuse
- Aging, Medicines and Alcohol [PDF]
- The Prevention of Substance Abuse And Misuse Among the Elderly [PDF]
Rehabilitation and Treatment for Seniors
There’s been more research on the successful treatment of addiction in the elderly population in recent years, but there are still many misconceptions, even in the healthcare profession. Substance Abuse Among Older Adults, a publication of the U.S. Department of Health and Human Services, points out several myths surrounding substance abuse treatment in the elderly population:
- Treating addiction in elderly patients is not worthwhile.
- Alcohol and substance abuse problems cannot be successfully treated in the aging population.
- Treating substance abuse problems in seniors is a waste of healthcare resources.
But these misconceptions represent a dangerous way of thinking. Potential drug interactions and the tendency of alcohol and drug abuse to trigger new chronic health problems or worsen existing problems make substance abuse in the elderly a serious health concern. Further, research has shown that substance abuse can be successfully treated in seniors.
Treating chronic pain in patients with substance abuse disorders is challenging, but a number of treatment models and frameworks have emerged that aim to minimize risks. With careful monitoring and evidence-based methodology, it’s possible to effectively manage chronic pain without jeopardizing recovery.
These 5 resources offer helpful information on rehabilitation and treatment options for seniors:
- Substance Abuse Relapse Prevention for Older Adults [PDF]
- Linking Older Adults With Medication, Alcohol, and Mental Health Resources [PDF]
- Are there specific drug addiction treatments for older adults?
- Substance misuse in older people 2: identifying and treating substance misuse
- Substance Abuse Among Older Adults: Treatment Improvement Protocol [PDF]
With more research illustrating the prevalence of substance abuse among senior citizens and the effectiveness of targeted treatment options, there is hope for families of aging loved ones concerned for their elderly loved one’s health and safety. Caregivers should be aware of the risk factors and potential warning signs to address suspected substance abuse as soon as it’s recognized, so that treatment interventions can be discussed with clinicians as soon as possible.