Elderly Substance Abuse

Signs, Treatment and More

Elderly substance abuse is a tricky subject. Not only can the signs be mistaken for other problems such as dementia or depression but the abuse can sometimes be unintentional.

Substance abuse in the elderly is most often seen in the form of alcoholism but can also be abuse of illicit drugs, nicotine, over-the-counter medications and prescription medications.

Drugs:

Illicit drug use is relatively rare, as the majority of users do not maintain use outside of their thirties or forties, but reports are that alcohol abuse exists in approximately 2 – 10% of the elderly population. Physiology changes as a person ages and their body responds differently to medications, drugs and alcohol than it did when the person was younger.

Alcohol:

Seniors who abuse alcohol are generally separated into two groups, those that have been abusing alcohol for many years and have reached age 65 or over and those who began abusing alcohol later in life. Elderly substance abuse that begins later in life is often triggered by life changes such as death or separation from a family member, retirement, reduced income, health concerns, sleep impairment and/or family conflict.

Age-related changes effect the absorption of alcohol in the body. It is absorbed at a higher rate and the same amount of alcohol produces higher blood alcohol levels. Alcohol can also interfere with common medications, such as benzodiazepines, and increase the risk of fall-related injuries and other significant adverse reactions.

The recommendation for alcohol use in the elderly is a "small amount" which is no more than one drink per day and no more than two on any special occasion. One drink = 5 ounces of wine, 12 ounces of beer or 1.5 ounces spirits.

Nicotine:

Nicotine dependence is also a significant problem in the elderly. Use early in life increases the risk of mortality from this addiction. Elderly smokers not only continue to impair their respiratory systems, but are also more likely to die from respiratory diseases. Nicotine replacement products work successfully in this group, especially when combined with behavioural, supportive and other therapies.

Medications:

The elderly are at risk for elderly substance abuse that can either be intentional or unintentional. Seniors may take extra medications in attempt to relieve pain and other symptoms more quickly or may abuse their medications or other drugs as an attempt to alleviate symptoms of depression in the elderly.

Seniors may unintentionally over-use medications as they may have a complicated medication schedule and/or a large number of medications for multiple ailments. In either case, it can be quite easy to mismanage medications. Other changes such as short term memory loss can further complicate a person's ability to properly self-administer medications.

Often over-use can be related to multiple chronic health conditions being treated by several physicians. For example, an individual may be seeing a family doctor for general health needs and specialists for specific diseases or illnesses. If these physicians are not communicating, the patient can be over-medicated and end up in serious difficulty.

Some seniors who live on or below the poverty line may have difficulty affording medications and will often be under-medicated.

The result of mismanaging medications can include unsuccessful treatment of illness, drug overdose, drug reaction, or inter-reaction and, in some cases, death. Elderly substance abuse is a situation that needs careful monitoring by both caregivers and health professionals in order to prevent needless tragedy. See the quick tips below for suggestions on how to assist with this.

For prescription or over-the-counter medications, the recommendation is to work closely with the physicians who write the prescriptions and the pharmacists who fill them. Use the same pharmacy for all prescriptions if possible. As pharmacists should keep track of all prescriptions filled for the individual, they can quickly spot overuse of a particular drug or when two drugs used together are likely to cause an adverse reaction. If a generic drug (one without a brand name) is offered or used to fill a prescription, make certain the doctor approves of the substitution.

For more information on how to ensure your loved one's medication regime is safe, refer to Elderly Medication.

Signs of Substance Abuse

It is more difficult to notice elderly substance abuse when an individual lives alone. Though it could be another health condition, substance abuse should be considered as well if there is memory loss, depression, repetitive falls and injuries, legal problems, chronic diarrhea, fluctuating moods, malnutrition and recent isolation.

Symptoms of alcoholism and elderly substance abuse can easily be mistaken for what many people think of as "natural"" symptoms of aging. Confusion, depression, memory loss and loss of interest in activities not only may be signs of aging but also symptoms of drug, alcohol or medication abuse.

Elderly substance abuse will not present with the normal red flags of addiction such as change in employment, absenteeism and withdrawal from society as they usually are retired and engage in fewer activities socially.

The following signs may indicate an elderly substance abuse related problem:

Difficulty with memory after having a drink or taking a medication
Decreased coordination: frequent falls or walking unsteadily
Failing to bathe or keep clean
Chronic diarrhea
Changes in sleeping habits
Unexplained bruises
Lack of interest in usual activities
Sadness, irritability, depression
Unexplained chronic pain
Changes in eating habits
Desire to be alone most of the time
Having trouble concentrating
Difficulty staying in touch with family or friends
Legal problems

Treatment of Substance Abuse

Work with the healthcare team including the pharmacist and physician. There are screening tests that can be used to help determine if elderly substance abuse is a problem
An involved family that has a good idea of the senior's daily life can be very helpful to identify medical and social problems and changes
It is important that a medication inventory be kept for your loved one. For prescription or over-the-counter medications, the recommendation is to work closely with the physicians who write the prescriptions and the pharmacists who fill them. Use the same pharmacy for all prescriptions if possible. As pharmacists should keep track of all prescriptions filled for the individual, they can quickly spot overuse of a particular drug or when two drugs used together are likely to cause an adverse reaction. For more information on how to ensure your loved one's medication regime is safe, refer to Elderly Medication.
If your loved one sees a specialist or has been in hospital, ensure their family physician is aware of any changes in medications and has reviewed the new medications are safe with their old medications
Exercise
Consideration of clinical treatment/ psychotherapy
Possible pharmacological interventions, such as antidepressants, in addition to clinical treatment as prescribed by a physician
Twelve-Step, self-help and support group participation should be considered.
Nicotine replacement products work successfully in this group, especially when combined with behavioural, supportive and other therapies
If your loved one is abusing any substance, it is also important to address this and bring out other pleasures in their life – like helping them join a social club, getting involved in volunteer activities and more regular visits with family and friends.

The following suggestions may be beneficial in helping your loved one to decrease elderly substance abuse:

Be Active - Active, involved seniors usually have a greater life satisfaction, higher morale and lower incidence substance abuse than those who are isolated, withdrawn and inactive. Though some seniors are content with solitary or inactive lifestyles, increasing the amount of meaningful activity and involvement reduces the need to engage in substance abuse in many others.
Participate - Participation in volunteer, vocational, leisure or social activities (the activities need to be interesting and meaningful to the senior citizen. This may take some exploring before pushing this person into any activity)
Seek Help - Knowing how to seek help that will lead to formal assessment, diagnosis and development of treatment plan
Increase Function - Attempts to increase functional ability (ie. safety equipment, community access through handydart, taxis, buses; dressing aids, participation in exercise programs, etc.)
Meet New Friends - Finding new friends or activities, encouraging engaging in or rejoining social activities (this advice may sound simple, but does work)
Become Involved in Community - Accessing community programming for seniors through seniors centers, health programs or church programs