Addiction in the Elderly

There are two types of addicts among senior citizens: the hardy survivor and the late-onset group. The hardy survivors are those who have been abusing drugs for a long time and have turned 65 years old, while the late onset group are those who become addicted later in life.

Addiction among the elderly is a hidden problem no one seems to be talking about. The signs of drug dependence and alcoholism are different than in younger adults, so this might be easily misdiagnosed or overlooked as an age-related problem.

As the number of older people increase, the rate of illicit drug use among the elderly rises. In 2002, there were only 2.7% of individuals aged over 50 abusing drugs. This number increased to 6.3% by 2011.

Older adults might not see the need for addiction treatment during the early stages. However, when they are ready for treatment, there are specialised rehab facilities that provide the highest level of care, geared towards helping them make a full recovery.

Addiction in the elderly

Why do older people abuse drugs? Is it because your children have left home and your large house now feels too big and you have to move into a smaller home? Do you find yourself lonely as friends grow fewer and farther away? Is it your failing health that frustrates you? Whatever your reasons, it’s clear to see that there are difficulties associated with ageing that are harder for some to accept or deal with than others.

Drugs have always been an escape; this is the biggest attraction if you have a substance use disorder. You might be using drugs to cope with changes to family obligations, health, lifestyle, work roles, support system or loss of mobility, as well as physical pain and stress.

Many of today’s elderly were among the first wave of people to try drugs in the 1960s and early 1970s when drug experimentation was a part of socio-culture. Some might be returning to old habits to cope with recent changes.

The growing problem of prescription drug addiction in the elderly

Typically, you won’t fit the profile of a drug addict as a senior citizen, but statistics show that 40% of prescriptions are sold to seniors in the US – usually for problems like insomnia, chronic pain and anxiety.

One of the major reasons for this problem is the myriad of medications doctors prescribe for older citizens. According to a fact sheet from Must for Seniors, two in five senior citizens are taking five or more medications at the same time. The NHS estimates that the number of substance abusers among older citizens will rise to 50% by 2031. You’re likely to have more than one prescribing doctor whilst living with a chronic health condition that requires several medications to treat.

Abuse doesn’t begin with an intention to abuse drugs. Some of the medications probably won’t have addictive properties, but the familiarity of pill-taking, combined with the interactions of painkillers, sedatives and stimulants can lead to moderate to severe addiction.

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Spotting the signs of substance abuse in the elderly

It is difficult to spot the signs of drug dependence and alcoholism in the elderly. It could be masked as signs of ageing or a bad reaction to a cocktail of prescription medications. As they age, some might give up activities they love, find it harder to sleep at night, neglect hygiene, become depressed and anxious when children leave home and experience changes in appetite. In younger people, these are warning signs of addiction, but in older people they are expected.

Some signs of substance abuse to look for include:

  • Incontinence
  • Gastrointestinal pain
  • Shallow breathing
  • Noticeable memory difficulties
  • Poor motor skills
  • Habitual boredom
  • Sleep disorders
  • Worsened medical conditions such as diabetes, liver disease and heart disease
  • Increased sensitivity to alcohol and drugs
  • Increased accidents and injury
  • Feelings of disorientation and delirium
  • Drug overdose or alcohol poisoning

Elderly citizens are at increased risk of co-occurring disorders such as schizophrenia, depression and anxiety. If you are already experiencing mental health issues, substance abuse worsens and intensifies the symptoms.

Causes of drug addiction in the elderly

Retirement

Retirement could be a trigger for substance abuse. You may have been working your whole life to provide for your family. Suddenly, they’ve all moved out and there’s no need to work anymore. All the downtime and idleness after the strong identity you’ve had at a company where you’ve worked for decades can lead to depression.

Debt

If you were admitted to hospital and accumulated a huge medical bill upon your release after being prudent your entire life, the thought of losing all your retirement funds might trigger substance abuse.

Surgery

Substance abuse is also driven by injuries and health problems which you’re more susceptible to suffer as you age. Hip replacements, arthritis and back pain are just a few medical conditions that require opioids. You can take these powerful painkillers to relieve pain, but addiction sets in quickly if any of the issues discussed above are present.

As you get older and watch friends and loved ones pass away one after the other, the reality of death hits you hard. Relocating to a nursing home, where you’re surrounded by a higher number of older people (who will subsequently die) is another trigger that often goes unacknowledged.

Dangers of drug abuse among the elderly

As you get older, you’re more prone to poor physical health, decrease in total body water and lean body mass. When you abuse drugs, it increases the risk of liver failure (an organ that detoxifies and metabolises alcohol and drugs). Your liver works extra hard when you abuse substances as a senior citizen. The substances remain longer in the body, because the liver works slowly, increasing the chances of building tolerance and dependence on drugs and alcohol.

Even when you follow doctor’s orders with medication such as benzodiazepines and opioids, you have a high risk of building dependence on such substances. Doctors can fail to exercise caution when prescribing medication to the elderly. They can also fail to consider the plethora of medication you might be taking concurrently and the role of drug interaction in physical and mental health. Benzos cause extreme sedation in seniors, while opioids increase the risk of addiction.

Other dangers of drug abuse in older citizens include:

  • You’re more likely to suffer psychological and physical damage resulting from drug abuse
  • With fewer responsibilities and commitments, it’s easier to engage in substance abuse
  • Alcohol reduces liver enzymes that metabolise and change the fat to water body ratio
  • There’s a lower tolerance for illicit substances and alcohol as you age
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Types of substances that the elderly tend to abuse

Alcohol

According to Psychiatric Times, alcohol is the most commonly abused substance in older adults. You might have started when you were younger and carried alcoholism into your later years or even started drinking after retirement. Regardless, alcohol damages the mind of an elderly person more than a younger adult.

The National Institute on Ageing (NIA) advises people over 65 not to drink more than seven units per week. Metabolism slows as you age, causing alcohol to have a greater effect in smaller amounts. Simply put, you can’t drink the same volume you drank when you were 25, as you’ll become intoxicated with less than half the amount. There are over 88,000 alcohol-related deaths in the US annually and adults aged 65 and older have the highest rate of fatality from that figure.

Prescription medication

People aged 65 and older consume 33% of the total prescription medications issued every year. Elderly citizens are developing opioid and benzo addiction faster than ever. Doctors are not as guarded when prescribing medication for older adults compared to younger people, because they believe you’re less likely to abuse pills or that you need them more to manage pain.

If you take benzos and opioids, you’re at a high risk of dependence and addiction, whether you’re following doctor’s prescriptions or abusing drugs as a recreational user.

Marijuana

Marijuana is growing in popularity among those aged 50 and above. The drug was popular in US socio-culture scenes during the 1960s and if you experimented with cannabis then, you’re likely to use something you’re familiar with today.

Staging an intervention for an older or elderly addict

The National Survey on Drug Use and Health revealed that 5.2% of individuals aged 50 and older have abused illicit substances and alcohol. Holding an intervention can be helpful if it’s well planned and perfectly executed, as one mishap could push your loved one back into the vicious cycle of addiction.

The first step is putting together an intervention team, made up of close family and friends.

A small group is recommended, so an elderly citizen doesn’t feel attacked or overwhelmed. Participants will include children, spouses, religious leaders, caregivers, housemates and friends. Participants who are older are preferred and discussions during the intervention shouldn’t be embarrassing to the elderly adult in question.

Refrain from calling your loved one an alcoholic or an addict, as they are very resistant to those word choices. These labels are more likely to make them shut down before you make any progress. Stick with accurate, descriptive words, such as the number of pills you noticed they take, the large quantity of liquor they’re consuming or the amount of money they’re spending on sustaining their addiction.

The sole purpose of the intervention is to help your loved one acknowledge the problem of addiction or abuse and accept professional help to kick the addiction. Prepare your statements beforehand, telling your loved one how their actions have impacted on you and that the only reason you’re mentioning it is because you want them to get the treatment they need.

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Hidden epidemic of elderly drug addiction

There is a growing concern over drug abuse amongst elderly people older than 65 years of age. It is particularly worrisome, because addiction or warning signs of substance abuse are harder to spot or often ignored. A study suggested that 2.5 million senior American citizens have an alcohol use disorder – a figure that shows addiction among the elderly is not being given the attention it deserves. In the UK, between 1992 and 2008, individuals aged between 55 and 74 experienced the highest alcohol-related deaths.

A few reasons why addiction remains hidden amongst the elderly include:

  • Many older people live alone
  • Most retired citizens have fewer responsibilities, making it easier to indulge a drug habit
  • The idea that retirement and a lifetime of hard work has earned you the right to comforts like recreational drug use
  • Symptoms of drug use are often masked as natural signs of the ageing process
  • Loved ones assume that it’s inconceivable for someone who didn’t use drugs when they were younger to abuse drugs as senior citizens
  • You might have a cocktail of prescription medication for different medical conditions
  • Most diagnostic tools are geared towards younger people, not senior citizens

Guide to addiction prevention for seniors

The drivers of abuse are not the same for teen/young adults as for seniors. They don’t start out as recreational drug users seeking a ‘high’, but instead feel the need to self-medicate for physical and psychological conditions. Subsequently, they take anti-anxiety medications, antidepressants, hypnotic-sedatives and prescription pain medication.

Driving influences may include divorce, death of spouse or dear friend, adjustment to major lifestyle change such as retirement, chronic pain; loss of employment, debt, recovering from major surgery and history of substance abuse. Substance abuse is more dangerous for older people, as you’re at greater risk of complications from drug interactions and the adverse effects of psychological changes.

Early detection is key. It’s important for family members and caregivers to detect warning signs of substance abuse in older citizens. Caregivers and providers should have adequate training that equips them with skills to detect substance abuse and help a senior citizen get professional help.

Questions to ask if you suspect prescription misuse or abuse

  • Are they taking more drugs than initially prescribed? If they increased the recommended dose of their own accord, this can be seen as a warning sign.
  • Has behaviour and mood changed? Do they suddenly appear withdrawn, anxious and secretive?
  • Are they trying to excuse their increased drug use?
  • Do you notice that they go out with a pocket supply of drugs?
  • Are they frequently changing prescribing doctors and pharmacies?
  • Do they sneak out to take their medication?
  • Do they become defensive or annoyed when someone raises the issue of their drug use?
  • Do they feel sorry about taking medication?
  • Are they getting the same prescription from several doctors and drug stores?

How to help a loved one manage their prescriptions responsibly

  • Ensure they take the prescribed dose, as stated on the pill container.
  • Remind them to avoid taking sedatives, painkillers and alcohol with their medication.
  • Stay connected: know what medication they’re taking and its purpose.
  • Ask for a second opinion. A pain specialist might help with an alternative solution that doesn’t involve drugs.
  • Encourage them to take their current prescriptions with them during their annual checkup, for an updated record.
  • Control their access to medications if you notice it’s becoming a problem habit.
  • Consult with their doctor to devise a plan of action to solve the problem before it escalates.

Barriers to identifying and treating older adults with substance abuse problems

The complexities of interconnectedness of mental and physical health issues in older adults makes it difficult to diagnose and treat substance abuse. Barriers to effective treatment include:

Ageism: Society tends to ascribe negative stereotypes to older adults as an explanation for their problems, instead of looking for specific psychological, medical and social causes. Younger people are more likely to receive correct diagnosis than older people. When substance abuse is diagnosed, you’re less likely to receive treatment recommendations.

Lack of awareness: There is a general lack of awareness regarding the severity of the problem by loved ones and local communities at large. Shame, denial and stigma are all connotations of substance abuse worsened by age, religion, culture and gender. A combination of these factors makes it harder for you to seek treatment.

Clinical behaviour: Medical professionals have low index spotting addiction. In the rare chance that they do, it’s hard for them to apply diagnostic criteria to nonspecific symptoms. Addiction symptoms might be masked by mental and medical disorders, especially in educated women and affluential people.

Comorbidity: Comorbid conditions (such as cognitive impairment, medical complications and mental disorders) complicate proper diagnosis and dissuade medical providers from encouraging you to seek treatment.

Addiction treatment for the elderly is possible

While it’s hard to diagnose addiction and substance abuse in elderly people, it is possible to treat substance use disorder. Enrolling at a specialised rehab facility for senior citizens will help you and your family learn more about your addiction, detox from drugs and alcohol, identify triggers that led to substance use and learn to handle problems without drug usage. Treatment options include therapy, support groups, drug rehabilitation and medical detox.

What to look for in inpatient rehabilitation for senior citizens

Choosing the right residential treatment is important, but also difficult. Programmes that cater for senior citizens are desirable, because they have well-trained staff who specialise in gerontology. A few things to look for include:

  • Accessibility for wheelchairs and those with visual impairment and hearing loss
  • Expert therapists and medical professionals, who will treat co-occurring disorders and health issues, alongside addiction
  • Number of therapy programmes
  • Size of programme to ensure your loved one gets the highest quality of car

It is never too late to get help with your addiction, whatever your age. If you or someone you love has become dependent on prescription medication or other drugs, take the first step today and reach out for help.

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