Addressing Addiction Treatment Needs of Senior Citizens
In 2011, members of the baby boomer generation began turning 65 years old. With an estimated 43.1 million official senior citizens in 2012, increasing to 83.7 million by 2050, according to the United States Census Bureau, it is important to understand how the existing healthcare infrastructure and health crises like addiction already affect older adults.
Life expectancy is improving in the US. A person turning 65 in 1972 could expect to live a little over 15 more years; in 2010, a person entering the senior citizen demographic could expect to live almost 20 more years on average. However, substance abuse, polydrug abuse, and mental health can all affect how long a person lives after they turn 65 and how healthy they will be during that time. According to the National Council on Alcoholism and Drug Dependence (NCADD), there are about 2.5 million older adults struggling with alcohol or drug addiction.
Older Adults Are at Greater Risk
Senior citizens who abuse drugs are at a greater risk for serious health consequences compared to younger people struggling with addiction. In part, this is because senior citizens often already have multiple prescriptions, and mixing other substances with these drugs or misusing these prescriptions can cause an overdose or lead to organ damage.
Metabolism changes as people age, so older adults’ bodies are affected differently by substances, which can build up to harmful levels or affect the brain differently. Taking over-the-counter medications or drinking alcohol alongside multiple prescriptions can change the drugs’ effects in dangerous ways.
Abusing Prescription Drugs
The United States is experiencing an epidemic of prescription drug abuse and addiction. At the same time, older adults are more likely to receive multiple prescriptions, including intoxicating drugs like opioids, because they will struggle with more chronic conditions. Osteoarthritis, long-term injuries, mental health conditions, and side effects from substance abuse patterns at younger ages all mean older adults are more likely to have drugs to treat several conditions at once. Loneliness, untreated mental health problems, and chronic pain also put them at risk for developing substance abuse issues.
According to the Center for Applied Research and Solutions (CARS), which published a report on the elderly and potential prescription drug abuse, people aged 65 years old and older make up one-third of the population receiving prescription medications, although this age group represented only 13 percent of the US population in 2008.
Senior citizens are also more likely to mix alcohol with their prescription medications, which puts them at greater risk for overdose and related chronic health problems. Women who are 60 or older, according to CARS, manage five prescriptions on average for longer periods of time compared to their male counterparts. Older adults are more vulnerable to prescription drug misuse, not specifically abuse; they do not adhere to their doctors’ recommendations for safe consumption, which is risky among a population that must manage multiple prescriptions.
People ages 65 and older are more likely to receive prescriptions for several drugs, including:
- Opioids like morphine, oxycodone, hydrocodone, fentanyl, Dilaudid, and codeine
- Barbiturates to relax muscles and aid sleep
- Benzodiazepines to treat anxiety and insomnia, including Valium, Librium, Xanax, Halcion, and ProSom
- Stimulant drugs like Ritalin or Adderall for older adults with ongoing ADHD or sleep disorders
Misuse of prescription medications among senior citizens led to a 78 percent increase in emergency department admissions between 2006 and 2012; 11 percent of those admissions involved opioid drug abuse.
Taking Opioids for Pain vs. Abuse
Prescription painkillers have led to an epidemic of opioid abuse, especially illegal opioids like heroin, among millions of people across the United States. However, doctors still easily prescribe these substances to senior citizens to treat pain problems. This means that many people, such as grandchildren, can steal these drugs from their elderly relatives, and it also puts the older adults themselves at risk of addiction or misuse. Between 2009 and 2014, the number of opioid painkiller prescriptions written for people ages 65 and older increased 20 percent, which was double the rate at which that age group itself was growing.
A 2011 study of Medicare recipients found that, among those hospitalized for various conditions, 15 percent received a prescription for an opioid medication; three months later, when they should have been able to stop taking the drugs for pain, 42 percent of those older adults were still taking prescription narcotics.
Benzodiazepine Abuse in Older Adults
In the same five years that the rate of opioid prescriptions increased, benzodiazepine prescriptions also increased – by 12 percent, still faster than the rate at which the senior citizen population was increasing. By 2014, there were 28.4 million prescriptions for benzodiazepines just for people ages 65 and older.
Alcohol Use Disorder and Problem Drinking
Although senior citizens receive multiple prescriptions for several potent substances, the most abused intoxicating drug was alcohol. Reportedly, close to 3 million Americans ages 55 and older struggle with alcohol abuse, and that number is expected to reach 6 million by 2020.
A 2010 study published in the Journal of General Medicine investigated rates of alcohol abuse among older adults and found that problem drinking and mixing prescription drugs, along with associated comorbid conditions, affected about 10 percent of the older adult population. Nearly 35 percent of the study group was at risk for comorbid problems by mixing alcohol and prescription drugs. NCADD found that people who lost a spouse or long-term partner, who were over the age of 75, were the most likely to struggle with alcohol abuse problems. Nearly 50 percent of residents in nursing homes struggle with problem drinking.
Binge drinking is a problem among senior citizens, too. About 80,000 people every year die from alcohol-related causes, according to the Centers for Disease Control and Prevention (CDC), and about half of those deaths are caused by binge drinking specifically. While this form of substance abuse is most common among people aged 18-24, the CDC found that people ages 65 and older engaged in binge drinking on a regular basis. While young adults were more likely to drink more in one binge drinking episode, senior citizens were more likely to drink too much more than once a month. With changes in metabolism and more prescription drugs in their system, this practice is especially dangerous for this vulnerable population.
Other Illicit Substances of Abuse
While older adults are at greater risk from problem drinking and prescription drugs, they are less likely than the general population to abuse other illicit substances; they are less likely to begin abusing heroin instead of prescription opioids, cocaine, or other illegal substances. About 1 percent of the senior citizen population abuses these illicit drugs, according to the American Association of Retired Persons (AARP).
However, as the baby boomer generation ages into retirement, the number of older adults who have ever abused illicit drugs is increasing. In 2003, according to AARP, about 28 percent of retired adults had ever abused an illicit drug, like marijuana or LSD, but by 2008, that percentage increased to almost 36 percent.
Unique Issues among Senior Citizens
Circumstances around retirement, such as having adult children away from home, loss of a spouse or partner, and the death of friends, are unique circumstances among older adults, which can lead to psychological issues that can trigger addiction or substance abuse. Senior citizens are more likely to live alone in isolated circumstances. they are more likely to need help with daily life from caregivers, which can affect their self-esteem. They may have financial issues due to retirement subsidies, and seeing people close to them pass away are all issues that can cause depression, anxiety, and substance abuse. The Substance Abuse and Mental Health Services Administration (SAMHSA) found that 1.6 percent of older adults had thoughts of suicide in the past year; about 25 percent of older adults struggle with some form of mental health problem.
Ageism is a severe problem that older adults face, not just in general culture, but among doctors and nurses in the medical field. Caregivers, family members, and medical professionals are more likely to have different standards for happiness, wellness, and quality of life for younger adults than older adults. Some people may believe that they should let their elderly friends and family “enjoy” drinking too much or misusing medications because they have a limited time left. This is a false belief, as intoxicating and addictive drugs shorten lifespan for anyone, at any age, and abuse of alcohol and drugs is likely to be a symptom that something is wrong with the person’s mental health, which contributes to a lower quality of life.
The problem of ageism also makes it harder to recognize symptoms of mental illness and addiction in older adults. Physical challenges, memory issues, “crabbiness,” and lack of energy are associated with lower general health among older adults, but they are also symptoms of addiction. If an elderly person’s mental and physical health decline rapidly, it could be a sign of substance abuse, or it could be a sign of an underlying chronic condition. It is important for this person to be assessed by a medical professional to get appropriate treatment. This will help to rule out other conditions, like depression, diabetes, or dementia, which could be affecting the senior citizen instead.
- Getting the same drug from multiple doctors
- Filing a prescription frequently or at two different pharmacies
- Taking a prescription drug differently than how it is recommended
- Changes in behavior and sleep patterns
- Becoming more withdrawn, angry, irritable, or depressed
- Talking about the medicine a great deal
- Fear of running out of the medicine
- Reacting uncomfortably or defensively when the medicine is discussed
- Keeping “extra” pills in various places, like pockets, purses, or drawers
- Making excuses to take the medicine
- Drinking while taking the medication
- Lying about how often the medication is taken
- Having a history of substance abuse
While it is important to overcome substance abuse and addiction, older adults must still have access to their prescription medications. Many who struggle with alcohol use disorder, for example, may also suffer from chronic pain problems, so they may need access to opioid prescriptions while in rehab. As substance abuse is better understood as a disease, rehabilitation programs are integrating science-based information to help people with different needs, and this includes the needs of people ages 65 and up.
Some Treatment Suggestions for Seniors
SAMHSA has some treatment protocols that may help older adults overcome problem drinking and substance abuse. Some of these include:
- Brief interventions from counselors, doctors, caregivers, and social workers who may interact with the individual in diverse ways and recognize potential signs of addiction
- Motivational counseling to help seniors who do not want to seek treatment
- Patient placement in detox, rehabilitation programs, or hospitals based on intensity of care required
- Support groups with peers in the same age group
- Cultivating a culture of respect for elders
Getting help with a safe detox plan, entering a rehabilitation program focused on older adults, and staying in support groups with peers can help many senior citizens who struggle with addiction alongside other chronic health issues.