Substance Abuse in the Elderly: A Growing Problem

Abuse of alcohol among adults over the age of 65 has been estimated to be as high as 17 percent. Although seniors make up about 14 percent of the US population, they account for about 25 percent of yearly prescription drugs. As many of these prescriptions are for chronic pain, insomnia, and anxiety, this can be a dangerous cocktail for seniors. As the baby boomer generation continues to age, the number of cases of substance abuse in the elderly is predicted to double by the year 2020.

"As the ‘baby boom’ cohort ages, the extent of alcohol and medication misuse is predicted to significantly increase because of the combined effect of the growing population of older adults and the cohort-related differences in lifestyle and attitudes." —Geriatrics

A recent review published in the journal Geriatrics finds that seniors are less likely to fear prescription drugs than their parents and more likely to abuse them, especially if they are also abusing alcohol.

Dangerous Substances for Seniors

Seniors rarely obtain drugs illegally. They are more likely to get drugs by seeing multiple doctors, stockpiling medications over time, or getting medications from family members.  Doctors contribute to the problem by not recognizing the potential for substance abuse in the elderly and family members are often reluctant to voice their concerns or confront seniors.

 
• Alcohol. About 22 percent of seniors admit to drinking on a daily basis. Alcohol abuse in seniors may be a problem that begins earlier in life or it may be a problem that begins later due the loss of a loved one, retirement or illness. Women are more likely than men to start abusing alcohol later in life. A major problem for both men and women is that as we age we absorb alcohol more quickly and the effects of alcohol on the brain and the liver are increased. Another sobering fact is that suicide is more common in elderly men than in any other group, and alcohol is a frequent contributing factor.
 
• Benzodiazepines. These sedative drugs are commonly prescribed to seniors for anxiety, depression and trouble sleeping despite the fact that they are rarely effective for these problems. In most cases these drugs are prescribed not by mental health specialists, but by primary care doctors. Common "benzos" include Valium, Xanax and Ativan. Abuse of these drugs can contribute to gastroesophageal reflux, chronic obstructive pulmonary disease, falls and motor vehicle accidents. Studies show that sedatives combined with alcohol increase the risk of suicide in the elderly. Getting off these drugs requires care: Seniors who have been on these medications for a long time can have a serious withdrawl reaction that may require hospitalization.
 
• Opiates. Chronic pain is one of the most frequent complaints among seniors, and narcotic pain medication is one of the most frequently prescribed remedies. Common brand names of opiate pain relievers include Percoset, Vicodin, Lorcet and OxyContin. Physical dependence is rare in seniors who do not have a previous history of substance abuse. However, tolerance to opiates develops over time, which means the dose needs to be increased and this increases the potential for abuse.

Warning Signs for Caregivers

More seniors are living alone and studies show that living alone is a risk factor for substance abuse. It is also harder to detect substance abuse in the elderly if the senior lives alone, and seniors are unlikely to admit to this problem. So if you are a caregiver, you need to be aware of these substance abuse warning signs:

 
• Depression, sadness or loss of interest in activities, friends and family
 
• Memory loss, confusion or irritability
 
• Loss of coordination, falls or unexplained bruising
 
• Changes in sleeping habits, eating habits or weight loss
 
• Wanting to be alone most of the time
 
• Failure to keep up with physical hygiene or household chores

What Should Caregivers Do?

If you suspect alcohol abuse, let your senior’s health care provider know you are concerned. If you suspect drug abuse, get a shopping bag and collect all the prescription and over-the-counter medications in the house.  Take them to your senior’s heath care provider.  Health care providers have screening tests they can use to detect alcohol or drug abuse in seniors. They can adjust medications, change doses or eliminate unnecessary prescriptions.

The good news is that if substance abuse treatment is required, seniors respond just as well or even better than younger people.