Substance Abuse In TheSubstance Abuse In TheElderlyElderly

David Meshorer, Ph.D.David Meshorer, Ph.D.

Psychological HealthPsychological HealthRoanokeRoanoke

The The ““Invisible EpidemicInvisible Epidemic””

Substance abuse in the elderly is one ofSubstance abuse in the elderly is one ofthe fastest growing health problems facingthe fastest growing health problems facingthe countythe county

Even soEven so…….The problem remains:.The problem remains: UnderestimatedUnderestimated UnderidentifiedUnderidentified Under DiagnosedUnder Diagnosed Under TreatedUnder Treated

Alcohol and prescription drug misuseAlcohol and prescription drug misuseaffects up to 17% of older adultsaffects up to 17% of older adults

Relatively little research on alcohol use byRelatively little research on alcohol use bythe elderlythe elderly

Striking lack of research and outcome dataStriking lack of research and outcome dataon drug use and dependence in the elderlyon drug use and dependence in the elderly

Often drug trials of new medications doOften drug trials of new medications donot include older subjectsnot include older subjects

Government funding historically goes toGovernment funding historically goes toother substance abuse problems andother substance abuse problems anddifferent populationsdifferent populations

Substance Abuse DisordersSubstance Abuse Disorders

Compared to younger adults,Compared to younger adults,substance abuse disorders insubstance abuse disorders inthe elderly present more oftenthe elderly present more oftenas medical or psychiatricas medical or psychiatricconditionsconditions

Difficulties Identifying ElderlyDifficulties Identifying ElderlySubstance AbusersSubstance Abusers

Substance abuse by senior citizensSubstance abuse by senior citizensgoes undetected because they oftengoes undetected because they oftenare:are: No longer active in mainstream societyNo longer active in mainstream society Less likely to get in trouble with the lawLess likely to get in trouble with the law Retired- so less chance of drinking/drugRetired- so less chance of drinking/drug

abuse causing loss of job or otherabuse causing loss of job or othernegative consequencesnegative consequences

More likely thanMore likely thanyounger folks toyounger folks tohid substancehid substanceabuse problemsabuse problemsand less likely toand less likely toseek professionalseek professionalhelp- Stigma andhelp- Stigma andshame are greatershame are greaterin the olderin the oldergenerationgeneration

Family members are oftenFamily members are oftenashamed and embarrassedashamed and embarrassed

Family complicity-Family complicity-““GrandmaGrandma’’s cocktails ares cocktails arethe only thing that makesthe only thing that makesher happy.her happy.”” ““WhatWhatdifference does it make? Hedifference does it make? Hewonwon’’t be around mucht be around muchlonger anyway.longer anyway.””

There is a prevalent beliefThere is a prevalent beliefthat it canthat it can’’t be treatedt be treated

Alcohol Abuse/MisuseAlcohol Abuse/Misuse Major substance abuse problem amongMajor substance abuse problem among

older adultsolder adults Alcohol abuse is estimated to be 2%-20%Alcohol abuse is estimated to be 2%-20%

of the elderly populationof the elderly population Older, depressed, alcoholic male is theOlder, depressed, alcoholic male is the

highest risk for suicidehighest risk for suicide Rates of alcohol-related hospitalizationsRates of alcohol-related hospitalizations

similar to heart attack hospitalizationsimilar to heart attack hospitalization Trauma is the most common reason forTrauma is the most common reason for

alcohol-related hospitalizationsalcohol-related hospitalizations

Alcohol Abuse/MisuseAlcohol Abuse/Misuse

Elderly adults are likely to beElderly adults are likely to behospitalized without an alcoholhospitalized without an alcoholrelated diagnosisrelated diagnosis

Hospital staff less likely to recognizeHospital staff less likely to recognizealcoholism in the elderlyalcoholism in the elderly

May lead to serious withdrawal duringMay lead to serious withdrawal duringhospitalizationhospitalization

The National Institute on AlcoholThe National Institute on AlcoholAbuse and Alcoholism has identifiedAbuse and Alcoholism has identifiedpotential problematic alcohol use in thepotential problematic alcohol use in theolder adult as drinking more than oneolder adult as drinking more than onedrink daily- (1.5 ounces of alcohol, 12drink daily- (1.5 ounces of alcohol, 12ounces of beer, 5 ounces of wine)ounces of beer, 5 ounces of wine)

Alcohol Abuse/MisuseAlcohol Abuse/Misuse

In contrast with youngerIn contrast with youngersubstance abusers, the elderlysubstance abusers, the elderlyalcoholic or drug abuser is morealcoholic or drug abuser is morelikely to present with healthlikely to present with healthproblems than with criminal orproblems than with criminal orantisocial behaviorsantisocial behaviors

Alcohol Abuse/MisuseAlcohol Abuse/Misuse

““In the United States it is estimated thatIn the United States it is estimated that2.5 million older adults have problems2.5 million older adults have problemsrelated to alcohol and 21% of hospitalizedrelated to alcohol and 21% of hospitalizedadults over 40 have a diagnosis ofadults over 40 have a diagnosis ofalcoholism, with related hospital costsalcoholism, with related hospital costsestimated as high as $60 billion a year.estimated as high as $60 billion a year.””

(Schonfeld and Dupree)(Schonfeld and Dupree)

Risk factors for alcoholRisk factors for alcoholabuse in the elderlyabuse in the elderly

Prior history ofPrior history ofalcohol abusealcohol abuse

Family historyFamily history of ofalcoholismalcoholism

New onset medicalNew onset medicalproblemsproblems

Loss of a spouseLoss of a spouse Recent retirementRecent retirement Social isolationSocial isolation

Early OnsetEarly Onset

70% of elderly alcoholics70% of elderly alcoholics 14% of male population14% of male population 1.5% of female population1.5% of female population These patients have problems withThese patients have problems with

alcohol most of their livesalcohol most of their lives Likely to have a family history ofLikely to have a family history of

alcoholismalcoholism

Late OnsetLate Onset

30% of elderly alcoholics30% of elderly alcoholicsOnset is usually after 50Onset is usually after 50 Triggered by a major lifeTriggered by a major life

stressorstressor

Most late onset alcoholicsMost late onset alcoholicsare effected by:are effected by:

RetirementRetirement Social IsolationSocial Isolation Physical Health ProblemsPhysical Health Problems Grief and Loss Issues Grief and Loss Issues (Losses for older(Losses for older

people tend to be more irreversible, leadingpeople tend to be more irreversible, leadingto a sense of hopelessness, fatalism)to a sense of hopelessness, fatalism)

Housing Issues Housing Issues (Moving out of a home(Moving out of a homeoccupied for decades)occupied for decades)

Marital problemsMarital problems Mental health problems- particularlyMental health problems- particularly

depressiondepression

Late onset drinkers usually have:Late onset drinkers usually have: Fewer medical and mental health problemsFewer medical and mental health problems Stronger societal connectionsStronger societal connections Less likelihood of having been in aLess likelihood of having been in a

correctional facilitycorrectional facility Less likelihood of having been in alcohol orLess likelihood of having been in alcohol or

drug treatmentdrug treatment A better prognosis for recovery- since theyA better prognosis for recovery- since they

have not suffered the physical andhave not suffered the physical andpsychological ravages of long termpsychological ravages of long termsubstance abusesubstance abuse

The termThe term ““Hazardous DrinkingHazardous Drinking””

has been suggested.has been suggested.

(Menninger, 2002)(Menninger, 2002)

CAGECAGEInstrument most widely used by PCPInstrument most widely used by PCP’’ss

CC Have you ever felt you should Have you ever felt you should ccut ut down on your drinking?down on your drinking?

AA Have people Have people aannoyed you by criticizingnnoyed you by criticizingyour drinking?your drinking?

GG Have you ever felt bad or Have you ever felt bad or gguilty aboutuilty aboutyour drinking?your drinking?

EE Have you ever had a drink first thing inHave you ever had a drink first thing inthe morning as a the morning as a eeye opener?ye opener?

DrugsDrugs

The use of illegalThe use of illegaldrugs is uncommondrugs is uncommonamong elderlyamong elderlypeople but this maypeople but this maychance as babychance as babyboomers age-boomers age-

Over theOver thecounter drugscounter drugs

Elderly adults utilize more over-the-Elderly adults utilize more over-the-counter drugs than any other agecounter drugs than any other agegroupgroup

A combination of alcohol and over-the-A combination of alcohol and over-the-counter medications is the mostcounter medications is the mostcommon source of adverse drugcommon source of adverse drugreactions in the elderlyreactions in the elderly

Prescription DrugsPrescription Drugs

Elderly use prescription drugs 3x asfrequently as the general population-OTC use is even more extensive.

Prescription Drug UsePrescription Drug Use

The aging process with itsThe aging process with itsphysiological changes,physiological changes,accumulating health problemsaccumulating health problemsand other psychosocialand other psychosocialstressors makes prescriptionstressors makes prescriptiondrug use both more likely anddrug use both more likely andmore risky.more risky.

Prescription DrugsPrescription Drugs 83% of adults over 65 take at least one83% of adults over 65 take at least one

prescription drugprescription drug 30% of those over 65 take eight or more30% of those over 65 take eight or more

prescription drugs dailyprescription drugs daily The disproportionately greater exposure toThe disproportionately greater exposure to

meds by the elderly, coupled with age-meds by the elderly, coupled with age-related physiological changes andrelated physiological changes andproblems related to medicationproblems related to medicationcompliance, place this population at greatcompliance, place this population at greatrisk for adverse eventsrisk for adverse events

Prescription DrugsPrescription Drugs Benzodiazepines and opiates are the types ofBenzodiazepines and opiates are the types of

prescription drugs most likely to be abused byprescription drugs most likely to be abused byseniorsseniors

Approximately 20% of the senior population useApproximately 20% of the senior population usebenzodiazepinesbenzodiazepines

Benzodiazepine abuse more common in femalesBenzodiazepine abuse more common in females Even when taken as prescribed there is a dangerEven when taken as prescribed there is a danger

that tolerance, dependence and toxicity maythat tolerance, dependence and toxicity maydevelopdevelop

Longer acting benzodiazepines can increase risk ofLonger acting benzodiazepines can increase risk offalls and hip fracturefalls and hip fracture

Slurred speech, ataxia and delirium may resultSlurred speech, ataxia and delirium may result

Implications forImplications forPublic Health PlanningPublic Health Planning

Alcohol and drug use in the geriatric populationAlcohol and drug use in the geriatric populationis associated with increased risk of medicalis associated with increased risk of medicalillness, injury, psychiatric disorders,illness, injury, psychiatric disorders,socioeconomic decline- all placing an increasedsocioeconomic decline- all placing an increasedburden on healthcareburden on healthcare

Currently, 23% of Medicare payments forCurrently, 23% of Medicare payments forhospital care are substance-abuse relatedhospital care are substance-abuse relatedproblemsproblems

Conclusion- Substance abuse in the elderly is aConclusion- Substance abuse in the elderly is asignificant public health problemsignificant public health problem

NOTNOT““Just OldJust Old””