| This
year, the first wave of “baby boomers” will turn
60, a phenomenon widely referred to as the “graying
of America.” What’s less frequently discussed
is a phenomenon that’s growing just as quickly, the
prevalence of substance abuse among the elderly.
According
to the U.S. Bureau of the Census, by the year 2030, older
adults will account for 21 percent of the population, as compared
with 13 percent in 1990. Between 1990 and 2030, the number
of adults over 65 will grow by 2.8 percent annually.
As
that population swells, substance abuse among those persons
60 years and older threatens to become one of the fastest
growing health problems facing the nation. It has been estimated
that up to 17 percent of older adults are affected by substance
abuse of alcohol or prescription drugs.
While
the problem is growing, awareness and treatment have not kept
pace. Until recently, the issue was largely ignored in gerontological
and substance abuse literature, and has generally been underestimated,
under identified, under diagnosed, and under treated. The
lack of response has been attributed to:
- Misdiagnosis:
health care providers tend to mistake symptoms for dementia,
depression and other problems common among the elderly
-
Shame: many older adults are reluctant
to seek help for a problem they consider to be private.
Adult children may also be ashamed of the problem and choose
not to address it.
-
Ageism: An unspoken but pervasive assumption
that it’s “not worth it” to treat older
adults reflects the different quality-of-life standard that’s
often applied to older adults.
As
a result, thousands of older adults need help, but don’t
get it.
Furthermore,
substance abuse takes a greater toll on older adults than
on their younger counterparts. The biological component of
aging influences the effect that these substances have on
the body. Additionally, there are psychosocial issues unique
to older adults – such as life events that increase
the likelihood of depression and the increased incidence of
multiple prescription drug use – that accelerate the
risk of overuse. These issues affect the two predominant kinds
of drugs used by older adults: alcohol and prescription drugs.
Alcohol
Abuse
Alcohol
abuse constitutes the most prevalent form of substance abuse
among older adults, with rates ranging from 3 to 25 percent
for "heavy alcohol use" and from 2.2 to 9.6 percent
for "alcohol abuse." Surveys of elderly patients
find symptoms of alcoholism in:
- 6
to 11 percent of patients admitted to hospitals
- 20
percent of patients in psychiatric wards
- 14
percent of patients in emergency rooms
The
prevalence of problem drinking in nursing homes has been found
to be as high as 49 percent in some studies.
Moreover,
because aging affects how alcohol is processed by the body,
older individuals may be subject to greater problems, even
if their drinking habits haven’t changed. Research has
suggested that as people age they become more sensitive to
the effects of alcohol. Additionally, some medical conditions,
such as high blood pressure, ulcers, and diabetes, can worsen
with alcohol use. Finally, many medicines can become dangerous
or deadly when mixed with alcohol. Since the average person
over age 65 takes at least two medications a day, the risk
of interaction is increased in the elderly population.
Prescription
Drug Use
Of
the current population of adults over 65, an estimated 83
percent take at least one prescription drug, and 30 percent
take eight or more prescription drugs daily. The majority
of these prescriptions for older adults are for psychoactive,
mood-changing drugs that carry the potential for misuse, abuse,
or dependency.
As
with alcohol, the use of prescription drugs carries a variety
of age-related risks, including changes in drug metabolism,
interactions among prescriptions, and interactions with alcohol.
Additionally, older adults may misunderstand directions for
appropriate use, or may receive multiple prescriptions from
physicians who are not informed about their colleagues’
actions. This unintentional misuse can progress into abuse
if the patient continues to use the drug non-therapeutically.
Treating
Substance Abuse in Older Adults
While
substance abuse treatment is often overlooked for older adults,
studies indicate that elderly persons with alcohol problems
are at least as likely as younger persons to benefit from
alcoholism treatment, though this population does present
certain challenges. Because shame is an influence for this
population, intervention strategies need to be especially
non confrontational and supportive. Acceptable consumption
levels also must be adjusted to reflect the effects of aging
on sensitivity to drugs and alcohol.
Health
care providers must develop the tools to recognize the symptoms
of addiction, and work to counter stereotypes that block treatment.
As this segment of the population grows, it is imperative
to develop a response that will provide the support required
for successful treatment.
Sources:
National Institute on Alcohol Abuse and Alcoholism of the
National Institutes of Health. Alcohol
Alert: Alcohol and Aging, no. 40, 1998.
National
Institute on Aging of the National Institutes of Health. “Alcohol
Use and Abuse.” September 2002, reprinted September
2005.
The
Florida Alcohol and Drug Abuse Association. “Chemical
Dependency and Older Adults.”
SAMHSA/CSAT.
Treatment
Improvement Protocol (TIP) Series 26: Substance Abuse
Among Older Adults, 1998. |
