upon completing this course leaner will be able to: list and define terminology associated with...
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Substance Abuse & The Elderly
Learning ObjectivesUpon completing this course leaner will be able to:
List and define terminology associated with substance abuse
Demonstrate the skills to recognize symptoms of substance abuse/misuse
List and define Models of Substance Abuse
Identify and define the Classification of Drugs
Learning Objectives
Identify the obstacles involved in providing effective services
Develop an understanding of the current issues surrounding substance abuse/misuse in the elderly population
Identify how the elderly are at risk for developing a substance abuse problem
Demonstrate knowledge of the cultural/societal factors that influence the increase in substance abuse/misuse within the elderly population
Overview:Recognizing Substance Abuse/Dependence
A heightened need for the substance
This need leads to patterns of behavior associated with the substance
Upon discontinuation of the substance, the individual experiences various levels of withdrawal symptoms
The willingness to continue use of the substance in spite of apparent consequences
Terminology
Substance Abuse and Misuse
Physical Dependence
Withdrawal
Routes of Administration
Set and setting
Tolerance
Synergism
Definitions of Terminology
Substance Abuse/Misuse
The primary distinction between substance abuse and substance misuse involved the quality of intention: abuse is deliberate ~ misuse is not.
Abusive use of a substance requires an awareness that the frequency or quantity of use is inappropriate.Misuse of a substance involves the continuation of the behaviors despite all knowledge of the physical, psychological, and/or social consequences that are likely to result.
Definitions
Physical Dependence
Person cannot stop taking a certain drug without suffering symptoms from physical withdrawal
Definitions
Withdrawal
Physical symptoms from stopping the use of the drug
Definitions
Routes of Administration
Method of ingestion of the drug ~ how the substance gets into the blood stream
Definitions
Set and Setting
Set refers to the user’s state of mind
Settings is the physical environment
Definitions
Tolerance
Person requires increasingly larger doses to achieve the same effect
Definitions
Cross-tolerance
Tolerance to other substances that share similar chemical structures
Definitions
Synergism
The combined effect of two substances, for example alcohol and tranquilizers, enhances or increases the effect of the other producing what is called a synergistic effect…1 + 1 does not = 2, but 4,5,or 6.
This is very common with people who accidentally overdose. And can be fatal for elderly people who are unaware of drug combinations.
Models of Alcohol & Drug Dependence
Disease Model
Tension Reduction Model
Family
Self-medication
The Disease Model
The AMA declared alcoholism a disease in 1957 based on three criteria for a condition to be called a disease.
it has a known cause symptoms get worse over time known outcomes
Tension Reduction Model
The body needs to return to Homeostasis or balance out
the physiological responses caused by stress, anxiety, conflict, frustration
Alcohol/drugs are used to reduce these experiences.
Self-Medication
An active attempt to numb the feelings and/or minimize other issues
This behavior suggests that the individual learned to self-medicate in order to cope with life situations
Family
Imbalance and maladaptive resolution of family issues
Inappropriate boundaries
Poor communication dynamics
Shame, abandonment, and rejection
Classification of Drugs Non-Psychoactive drugs are substances that in normal
doses do not directly affect the brain, such as vitamins, antibiotics, and topical skin preparations.
Psychoactive drugs affect brain functions, mood and behavior and are subdivided primarily on the basis of physiological and psychological effects.
Classification of Drugs
1. Narcotic Analgesics (pain reliever)2. Central Nervous System Depressants3. Central Nervous System Stimulants4. Hallucinogens5. Cannabis sativa: marijuana and hashish6. Inhalants: volatile solvents7. Phencyclidine (PCP)
Classification of Drugs
Narcotic Analgesics
Although considered CNS Depressants, Narcotic Analgesics refer to opium and the opiate derivatives, such as morphine, codeine, percodan, and heroin.
Their primary purpose is to “kill pain”
Classification of Drugs
Central Nervous System Depressants
Most central nervous system (CNS) depressants are sedative hypnotics and include:
Alcohol
Barbiturates
Tranquilizers
Classification of Drugs
Central Nervous System Stimulants
• AmphetaminesRitalinCocaine/Methamphetamine
• Tobacco
• Caffeine
Elderly Substance Abuse/Misue
The issue of elderly substance abuse/misuse is reaching epidemic proportions among the population.
The Federal Substance Abuse and Mental Health Services Administration has characterized substance abuse as "under-estimated, under-identified, under-diagnosed and under-treated" among the elderly. And is referred to as the “invisible epidemic”
The reasons for this are varied, although may be the fact they are no longer active in mainstream society.
Recent census data estimates that nearly 35 million people in the United States are 65 years or older. Substance abuse/misuse among those 60 years and older (including misuse of prescription drugs) currently affects about 17 percent of this population. By 2020, the number of older adults with substance abuse problems is expected to double.
Source: 2002 National Survey on Drug Use & Health (SAMHSA)
Americans are Living Longer
8481
7775.473.770.869.768.2
47.34045505560657075808590
1900 1950 1960 1970 1980 1990 2000 2025* 2050*
Year of Birth
Lif
e E
xpec
tanc
y at
Bir
th
0
5
10
15
20
25
30
35
40 "Gen X & Y"
"Baby Boomers"
"Greatest Generation"
Source: 2002 National Survey on Drug Use & Health (SAMHSA
Estimated Cost of the Consequences of Substance Abuse Among Mature Women
INPATIENT HOSPITAL CHARGES ($10.1 BILLION)
NURSING HOME EXPENSES (12.2 BILLION)
• Medicare - $8.5 Billion• Medicaid - $338 Million• Private insurers/individuals -
$1.3 Billion
Only 2% was spent to treat the substance abuse problem itself
• Medicare - $1.4 Billion• Medicaid - $5.8 Billion• Private insurers/individuals -
$5 Billion
Source: CASA, Under the Rug: Substance Abuse and The Mature Woman, June 1998
Gender Issues Older men tend to have substance abuse/misuse problems
compared to older women; however, women are more likely than men to start drinking heavily later in life.
Substance abuse/misuse is more prevalent among persons who suffer a number of losses, including death of loved ones, retirement, and loss of health.
Women are more likely to be widowed, divorced, or live alone. They also tend to be diagnosed more with depression and as a result been prescribed psychoactive medications that increase the likelihood of complications .
Problems Specific to the Elderly
Complications of drug-alcohol interactions
Cognitive dysfunction
It is often mistaken for other conditions associated with the aging process.
Emotional factors – grief, loneliness, loss of youth
Many start drinking later in life
Problems Specific to the Elderly
Acute drug reactions are common in this age group
Alcohol/drug misuse potentiates other drug interactions
Coping attempts to deal with the stresses of aging
Physical illness/infirmity
Boredom/retirement
Problems Specific to the Elderly Health care providers often overlook substance abuse/misuse among
older adults because they don't know what to look for or they mistakenly assume that older adults cannot be successfully treated.
Older adults more often present their substance abuse/misuse problems in the form of medical and social complaints.
Patients complain of a variety of problems which may be the effects of substance abuse/misuse.
Problems Specific to the Elderly Data on substance abuse is difficult to obtain
Medications are often used in nursing home environments to control behavior
Older females are likely to conceal any substance abuse/misuse problem with symptoms of depression and reliance on psychoactive
drugs
Problems Specific to the Elderly The broader society often stereotypes aging and the elderly in ways
that dismiss or disregard signs of a substance abuse/misuse problem
Family members may excuse an older relative's substance abuse/misuse as a result of grief or loss or a reaction to boredom. Or family members may not want to confront an elder, fearing they will offend or anger them.
Some signals to look for: 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 * Source ~ The Center for Substance Abuse Treatment
Assessment Complete medical or psychological history
Complete physical examination
Corroboration of all patient statements
Drug use history
Family history of addiction
Problems specific to the elderly
Some relevant issues in developing prevention, detection/diagnosis, and treatment programs for the elderly
Elderly persons use prescription medications approximately three times as frequently as the general population
Age-related brain changes Changes in drug sensitivity Use of different drugs Side effects more severe/more of an issue Different access to the drugs Different settings (i.e. nursing homes) Age-specific screening instruments needed Stigma Need better education re. prescription drugs Data systems to track prescription use
* Source – The National Institute on Drug Abuse
Treatment & Prevention Collaboration among health care providers, state agencies, and family members
Attention to patient’s physical & psychological condition
Active involvement of the family
Education of health care providers
Treatment for the Elderly = their own age group
Physicians and health care providers need to discuss alcohol use as well as medication management
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