A Growing Problem. Substance Abuse In The Eldery 1

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1 A Growing Problem Substance Abuse In The Eldery 1

2 A substantial and growing percentage of older adults misuse alcohol, prescription drugs, or other substances. The number of older adults in need of substance abuse treatment is estimated to more than double from 1.7 million in 2000 and 2001 to 4.4 million in 2020 Substance Abuse In The Eldery 2

3 Substance Abuse In The Eldery 3

4 Eva would probably have been called a "teetotaler." Except for an infrequent sip of wine on special occasions, she never drank alcoholic beverages. But after her children moved away and her husband and many of her close friends died, Eva turned to the bottle for escape and companionship. Now in her late 70s, Eva is an alcoholic. Substance Abuse In The Eldery 4

5 Harry has had problems with substance abuse since his late teens. Although drinking binges were often followed by periods of sobriety, he inevitably returned to his addictive ways. At 75, he is on several prescription medications, some of which should not be taken with alcohol. Substance Abuse In The Eldery 5

6 These two composite situations illustrate what has been called one of the fastest growing health problems in this country. Substance abuse among the elderly population. Substance Abuse In The Eldery 6

7 Discuss why the diagnosis of substance abuse is important in the elderly population Commonly abused substances Screening Treatment Recommendations Substance Abuse In The Eldery 7

8 With the aging population increasing so is the incidence of substance abuse within these adults. Therefore the need of: Appropriate Assessment Screening Tools Inpatient / Outpatient Treatment Education Prevention Planning Programs Ect. Substance Abuse In The Eldery 8

9 Recent census data estimates that nearly 35 million people in the United States are 65 years or older. 17 percent of this population, Substance abuse among those 60 years and older (including misuse of prescription drugs) By 2020, the number of older adults with substance abuse problems is expected to double. Substance Abuse In The Eldery 9

10 Drug abuse is often masked by the myth that addiction is a disease of the young and that if older people do develop a problem, it is with alcohol use only. What's more, symptoms of drug abuse such as forgetfulness and irritability may be dismissed as the person "just getting old." Substance Abuse In The Eldery 10

11 Even more worrisome, prescription drug abuse can lead to more dire consequences in the elderly. With age, the liver becomes less efficient at filtering out medications from the body. Because of this slowed drug metabolism, an older person may get addicted -- or suffer serious side effects -- at lower doses than a younger person would. These side effects include falls that can lead to debilitating fractures and an early death. Substance Abuse In The Eldery 11

12 Statistics suggest that drug abuse among older Americans is substantial and growing. A study in Annals of Epidemiology projected that the number of people age 60 and older abusing prescription drugs could increase 190% over the next two decades from 911,000 in 2001 to almost 2.7 million by Substance Abuse In The Eldery 12

13 Benzodiazepine and Narcotics are two of the most commonly prescribed drugs of abuse in the elderly. Alcohol and over-the-counter sleeping preparations are the two of the most common non-prescription drugs of abuse in patients over age 65. Marijuana is a commonly abused illegal street drug in the older patient While cocaine and heroin usage diminishes after age 60. Substance Abuse In The Eldery 13

14 As with any addictive substance, access increases the risk of abuse. Older people are more likely to get prescriptions for two leading types of drugs with potential for addiction: Opioid pain relievers Benzodiazepines. Substance Abuse In The Eldery 14

15 Among abused prescription drugs, opioids are the most notorious. For example: oxycodone (Oxy Contin), oxycodone/acetaminophen (Percocet) hydrocodone (Vicodin) These drugs can produce euphoria by indirectly boosting dopamine levels in the parts of the brain that influence our sensing of pleasure -- hence their addictive potential. Substance Abuse In The Eldery 15

16 The most common side effects of opioids are: nausea vomiting dizziness sleepiness constipation Itching During an overdose, opioids can slow down breathing, which can be fatal. Substance Abuse In The Eldery 16

17 Other potentially addictive medications are benzodiazepines such as: alprazolam (Xanax) clonazepam (Klonopin) diazepam (Valium) lorazepam (Ativan). Doctors commonly use these drugs to treat anxiety, panic attacks, insomnia, and acute stress reactions to traumatic experiences, such as the death of a spouse. Benzodiazepines work by slowing brain activity. Substance Abuse In The Eldery 17

18 When used properly -- in limited quantities for a short time -- addiction is usually not a problem. But taking larger doses or even typical dosages on a daily basis for an extended amount of time can easily lead to tolerance, and an individual will soon need larger and larger doses to get the desired effect. In addition, suddenly going off a benzodiazepine can trigger extreme anxiety and discomfort, prompting a desire to keep taking it. Substance Abuse In The Eldery 18

19 The health consequences of benzodiazepine abuse for older people include: memory impairment impaired reasoning confusion nodding off car accidents Falls Inpatient Treatment Mental Health Issues Substance Abuse In The Eldery 19

20 1. When talking with others, do you ever underestimate how much you actually drink (telling others you drink less than you do)? 2. After a few drinks, have you sometimes not eaten or been able to skip a meal because you didn't feel hungry? 3. Does having a few drinks help decrease your shakiness or tremors? 4. Does alcohol sometimes make it hard for you to remember parts of the day or night? 5. Do you usually take a drink to relax or calm your nerves? 6. Do you drink to take your mind off your problems? 7. Have you ever increased your drinking after experiencing a loss in your life (someone you love dies)? 8. Has a doctor or nurse ever said they were worried or concerned about your drinking? 9. Have you ever made rules to manage your drinking? 10. When you feel lonely, does having a drink help? Scoring: 2 or more YES responses indicates an alcohol problem. Substance Abuse In The Eldery 20

21 Although alcoholism usually develops in early adulthood, the elderly are not exempt. In fact, doctors may overlook alcoholism when evaluating elderly patients, mistakenly attributing the signs of alcohol abuse to the normal effects of the aging process. Recent studies indicated that between 1.1 and 2.3 million elderly citizens use alcohol to alleviate grief and loneliness Substance Abuse In The Eldery 21

22 Alcohol also affects the older body differently. People who maintain the same drinking patterns as they age can easily develop alcohol dependency without realizing it. It takes fewer drinks to become intoxicated, and older organs can be damaged by smaller amounts of alcohol than those of younger people. Also, many of the medications prescribed for older people interact adversely with alcohol. Substance Abuse In The Eldery 22

23 One in four older adults has a significant mental disorder. Among the most common mental health problems in older persons are: depression, anxiety disorders, and dementia. Over the next 25 years, the number of older adults with major psychiatric illnesses will more than double from an estimated 7 to 15 million individuals. Substance Abuse In The Eldery 23

24 A history of substance abuse is associated with increased risk of mental illness and likewise a history of mental illness is associated with a greater likelihood of a substance use disorder. Epidemiological studies indicate that 29 percent of individuals with a mental illness have a substance use disorder at some time in their lifetime. 37 percent of individuals with a substance abuse diagnosis have a lifetime prevalence of psychiatric illness. Substance Abuse In The Eldery 24

25 High rates of co-occurring mental health and substance use disorders are found in specialty geriatric psychiatry inpatient settings. For example, one fifth (20%) of older adults (age 60+) receiving treatment in a specialty geriatric psychiatry outpatient clinic were found to have a substance use disorder, including 11 percent with benzodiazepine dependence and 9 percent with alcohol dependence. Substance Abuse In The Eldery 25

26 Co-occurring addictive and psychiatric disorders can be associated with: poor health outcomes higher health care utilization increased complexity of the course and prognosis of mental illness stabilization heightened mortality higher rates of active suicidal ideation social dysfunction relative to individuals having either disorder alone Substance Abuse In The Eldery 26

27 Substance Abuse In The Eldery 27

28 As demographics change, so will attitudes about the use of alcohol and drugs. Substance Abuse In The Eldery 28

29 number in millions Number of Persons 65+, Year (as of July 1) Substance Abuse In The Eldery 29

30 "These individuals 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." Substance Abuse In The Eldery 30

31 Baby boomers are familiar with substance abuse, and many have carried the substance abuse of their youth into old age. As a person gets older and retires, they tend to have more time on their hands and they have less responsibilities. This can be a very lonely time and some people turn to substance abuse to fill the void in their life. Other seniors experience such unrelenting pain that they try to self-medicate it away. Substance Abuse In The Eldery 31

32 When people age, their sensitivity to alcohol increases as their tolerance decreases. Also, the percent of their body weight composed of water decreases, and alcohol-- which is water-soluble--affects them more quickly and to a greater degree. Substance Abuse In The Eldery 32

33 Alcohol takes longer to metabolize in older persons, accumulating in their bodies and leading to intoxication if consumption is not controlled. Because of their physical make-up, older women are more vulnerable to the negative effects of alcohol. Substance Abuse In The Eldery 33

34 As a whole, more older men have substance abuse problems than do older women But 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. Substance Abuse In The Eldery 34

35 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. Substance Abuse In The Eldery 35

36 Substance abuse cost Medicare two hundred thirty three million dollars ($233,000,000) per year in 1989, and accounts for a much larger expenditures today. Substance Abuse In The Eldery 36

37 Estimate may be low because study relied on physician diagnoses and substance abuse is often under-diagnosed in this population. The remaining 98% was spent on treating the consequences of substance abuse such as cancer, heart disease and hip fractures. Projected to cost $100 Billion in 20 years. Substance Abuse In The Eldery 37

38 Physicians often fail to recognize geriatric substance abuse for several reasons: (1) Lack of awareness (2) Embarrassment over screening for substance abuse (3) Failure to perceive the significance of substance abuse related medical problems (4) Therapeutic nihilism about the elderly, he is old, let him have his small pleasure. Substance Abuse In The Eldery 38

39 Anxiousness or irritability (feeling worried or crabby ) Memory loss (trouble remembering things) New problems making decisions Difficulty concentrating or paying attention Lack of interest in usual activities Sadness or depression Mood swings (happy one minute, sad or angry the next) Chronic pain (pain that doesn t go away) Problems with money or the police Falls, bruises, burns Incontinence (can t control urinating, wetting the bed) Headaches Dizziness Poor hygiene (not combing hair, bathing) Poor nutrition, changes in eating habits (eating junk food only) Out of touch with family and friends Suicidal thoughts (wanting to kill yourself) Strange response to medication Substance Abuse In The Eldery 39

40 The diagnosis of substance abuse in older individuals requires an appropriate awareness of its prevalence and appropriate screening of elderly patients. Most older individuals with substance abuse problems will deny symptoms, and usage. Surveys of elderly community based individuals indicate from 17 to 20% are receiving psychotropic medications. Almost half (44%) indicate use beyond the prescribed levels. Substance Abuse In The Eldery 40

41 Screening for alcohol abuse may include use of the CAGE or T-ACE, as a brief screening instrument C Cut Down A - Annoyed G Guilty E Eye Opener Substance Abuse In The Eldery 41

42 The statistics that researchers have come up with of elderly individuals in treatment may not paint an accurate picture of the problem as it stands today. This is because many elderly people are resistant to entering treatment or getting help for substance abuse. They may be too ashamed to admit to a problem or to seek help on their own Substance Abuse In The Eldery 42

43 However, studies show that older adults do as well as young people when it comes to treating substance abuse and that they may even do somewhat better. Older adults can recognize all kinds of benefit from treatment. Substance Abuse In The Eldery 43

44 There are often direct health benefits, improved with detox of substance abuse: cognition Independent living Better social connectedness New hobbies. The benefits are enormous Substance Abuse In The Eldery 44

45 Given the complexity and size of the current and future aging population, resources should be mobilized to modify and develop prevention and early intervention strategies to meet the specific needs and preferences of this rapidly growing group. Information regarding evidence-based prevention and early intervention programs for late-life substance abuse and mental illness needs to be organized and made readily accessible for program adoption and replicability. Prevention programming needs to be developed and tested so that the fast-growing older adult population is provided with state-of-the-art programs to reduce risk and improve protective factors for substance abuse and mental illness. Technical assistance is critically needed to support promising prevention programs and help them implement the high quality scientific evaluation necessary for elevation to evidence-based practices (EBP) status. As treatment demands increase, the substance abuse and mental health treatment systems will need a shift in focus to address the special needs of an older population of substance abusers. States and policymakers need to prepare for projected needs. Improved tools for measuring substance abuse and mental health problems among older adults should be developed. Substance Abuse In The Eldery 45

46 Substance Abuse In The Eldery 46

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