Substance Abuse in the Elderly. Tiffany Poon R3
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1 Substance Abuse in the Elderly Tiffany Poon R3
2 Objectives Discuss why diagnosis of substance abuse is important in the elderly Commonly abused substances Screening
3 Why is this important? Growing aging population leading to increased incidence of substance abuse among older adults Exacerbate medical problems experienced by elderly/med interactions Under diagnosed and under treated
4 What do these cases have in common? 70 yo M with HTN and T2DM whose BP and BG have responded poorly to appropriate medical management 75 yo M presenting with mood swings, family problems, memory loss, chronic insomnia 80 yo F who is malnourished, incontinent and living in a filthy environment.
5 Possible ways the elderly can present with alcoholism
6 Alcohol affects the Elderly Differently Age related decrease in lean body mass & total body water in relation to total fat resulting in decrease in total body volume and increase in serum EtOH concentration CNS sensitivity increases with age Medication interactions a concern Changes in liver and kidney function
7 Some Stats In 2010, Canadian Centre on Substance abuse reported proportion of seniors with EtOH problems was 6%-10% similar to other adult groups.
8 Types of Alcohol Abuse Early Onset: has been a heavy drinker throughout their life (2/3) Late Onset: Level of alcohol problematic later in life (post retirement, after loss of spouse, changes in health and independence) (1/3) Crisis Onset: periods of sobriety but restarts in response to major problems or changes
9 Risk Factors Bereavement and other losses (divorce, separation, health) Losses in social network (retirement, friends/neighbours moving away) Higher education and incomes.
10 Health problems associated with alcohol use Trauma/fractures GI complaints Myopathy Malnutrition Bladder/bowel incontinence Poor self care Aspiration pneumonia Falls Dementia/Delirium Peripheral neuropathy Hypertension
11 Underdiagnosed Problem May attribute effects of EtOH to changes related to aging Patient s embarrassment and shame leading to decreased discussion of EtOH use Fewer social and work responsibilities which can obscure functional loss
12 Screening CAGE Michigan Alcohol Screening Test- Geriatric Version (MAST-G)- Shortened version available Alcohol Use Disorders Identification Test (AUDIT)
13 CAGE Have you ever felt that you should Cut down on your drinking? Have people Annoyed you by criticizing your drinking? Have you ever felt bad or Guilty about your drinking? Have you ever had a drink first thing in the morning (Eye opener)
14 SMAST-G
15 AUDIT
16 Treatment Education and awareness by seniors and caregivers Peer led self help groups (Alcoholics Anonymous) Brief interventions Cognitive-behavioural treatment Psychosocial treatment Outreach services Pharmacological interventions
17 Prescription Drugs Canada is 2nd highest in list of all countries in the world for BZD use, 5th for narcotic use and within top 15 for stimulant use. Older adults, women, adolescents and Aboriginals at elevated risk of abuse Up to 20% of Canadians over 60 yo obtain long-term prescriptions for pain meds
18 Prescription Drugs Some studies estimate about 17% of seniors over 60 yo will experience Rx drug abuse Often pain meds and benzodiazepines, skeletal muscle relaxants & sleep aids Risk factors: female, social isolation, hx of substance abuse, mental illness, exposure to drugs with abuse potential
19 Illicit Drug Use Less than 1% admit using cocaine, marijuana, heroin Lifetime prevalence rate of 1.6% for illegal drug users over 65 yo Maturing out theory-drug dependence infrequently seen among seniors because they either grow out of addictions due to adverse consequences or die
20 Questions?
21 References Culberson JW. Alcohol Use in the Elderly: Beyond the CAGE. Geriatrics. 2006;61(11): Holbert KR, Tueth MJ. Alcohol abuse and dependence- A clinical update on alcoholism in the older population. Geriatrics. 2004;59(9): Beullens J, Aertgeerts B. Screening for alcohol abuse and dependence in older people using DSM criteria: a review. Aging and Mental Health. 2004;8(1): Culberson JW, Ziska M. Prescription drug misuse/abuse in the elderly. Geriatrics. 2008;63(9): Haydon E, Rehm J, Fischer B, Monga N, Adlaf E. Prescription Drug Abuse in Canada and the Diversion of Prescription drugs into the Illicit Drug Market. Canadian Journal of Public Health
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