How to Tell if Grandad’s Popping Pills

Alcohol and prescription drug misuse are common forms of drug abuse in the elder population, but short interventions can help.

June 17, 2009

Substance abuse among seniors is higher than you think.

RODALE NEWS, EMMAUS, PA—Sometimes, the golden years can seem very dark. Losing loved ones, isolation, and growing older drive a significant portion of the elder population to abuse alcohol, illicit drugs, and prescription and over-the-counter medications. This type of behavior is often overlooked at regular doctor’s office visits, but a Florida state-funded screening and intervention program that focuses on detecting and treating elderly drug abuse with several short sessions in their homes or senior centers has proved effective. The results of the program were just published in the American Journal of Public Health. “In most cases, depressive symptoms, loneliness, and boredom often precede alcohol consumption,” explains study author Lawrence Schonfeld, PhD, professor and chair of the University of South Florida’s department of aging and mental health disparities at the Louis de la Parte Florida Mental Health Institute. “It is likely they are the same triggers for intentional misuse of medications, as well as illicit drug use.”


THE DETAILS: Research suggests substance abuse in older adults isn’t easily detected during regular doctor’s appointments, so Schonfeld and colleagues, who created the Florida Brief Intervention and Treatment for Elders (BRITE) project, screened nearly 3,500 residents over a three-year period in their homes or at senior centers. The average age was 75. After the older adults completed the screening interviews, researchers found that 26 percent misused prescriptions, nearly 10 percent were referred to intervention treatment for potential alcohol problems, and 40 people, about 1 percent, used illicit drugs. Nearly 17 percent of those interviewed couldn’t remember how many medications they took. Nearly 65 percent of the adults also tested positive for depression. Levels of depression, alcohol, and drug abuse and misuse dropped after five brief in-home intervention sessions, in which patients were given instruction about how to properly use their prescribed medications. This pilot study helped secure a federally funded grant to expand the program to 15 counties in Florida.

WHAT IT MEANS: Substance abuse among the elderly has been dubbed a hidden national epidemic. While about 10 percent of the nation’s population abuses alcohol, that number jumps to as much as 17 percent when looking at adults 65 and older, according to previous surveys. It’s estimated that 2.5 million older adults suffer from alcohol-related problems. Some drank heavily their entire lives, but some turned to abusing substances later in life, sparked by retirement, death, separation from a family member, friend, or pet, along with concerns over health, trouble sleeping, or fights with family. Older adults’ bodies absorb alcohol quickly, and complications arise when drinks are mixed with prescription and over-the-counter medications. According to the New York State Office of Alcoholism and Substance Abuse Services, mixing prescription and over-the-counter drugs and alcohol can slow blood flow to organs, increase risk of falls and fractures (especially with drugs like Valium), and cause confusion that could lead to accidentally overdosing.

Here’s how to ID a problem and get help to fix it:

• Know the warning signs. Certain behaviors could be warning signs of substance abuse in the elderly, according to the national Center for Substance Abuse Treatment (part of the U.S. Department of Health and Human Services):

• Memory trouble after having a drink or taking a medication
• Loss of coordination (walking unsteadily, frequent falls)
• Changes in sleeping habits
• Unexplained bruises
• Being unsure of yourself
• Irritability, sadness, depression
• Unexplained chronic pain
• Changes in eating habits
• Wanting to stay alone much of the time
• Failing to bathe or keep clean
• Having trouble concentrating
• Difficulty staying in touch with family or friends
• Lack of interest in usual activities

• Recognize a prescription for problems. Older adults often misuse prescription drugs. Signs of a problem include: requesting refills more rapidly than prescriptions permit; having multiple prescribing physicians who are unaware of the others’ prescriptions, or having a doctor who is unaware of certain symptoms that another specialist is treating, says Schonfeld. So keep in contact with a parent or loved one’s physician and pharmacists. If you’re concerned, as the doctor about a screening test for the senior you’re worried about. “It would be very helpful if physicians implement screening and brief intervention for all patients,” says Schonfeld. “They can bill Medicare, and soon, in states that permit it, Medicaid, and even some private insurance for conducting these services.

• Analyze the medicine cabinet. Over-the-counter meds aren’t free of serious side effects, and those problems are often magnified when older adults mix them with alcohol. Using laxatives on a regular basis can cause chronic diarrhea, leading to a sodium and potassium imbalance that can threaten your heart. Antihistamines can cause confusion, and cold medicine can cause a spike in blood pressure, which can lead to a stroke. Make sure your senior knows how to safely use any OTC meds in his or her possession.

• Get help. Not all states offer screening, brief intervention, and referral to treatment (the type of help used in the study), but visit the Department of Health and Human Services’ Substance Abuse and Mental Health Services Administration to see if it’s offered in your area. Individuals with more serious drug problems may need more intensive treatment; check SAMHSA’s Treatment Facility Locator to search for facilities that specialize in treating older adults.

Tags: elder care
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