An advancing number of drug abusers are addicted to, not illegal drugs, but to medically prescribed drugs. An even more startling fact is that among those abusing prescription medications are the elderly. Incorrectly following the instructions on the medication bottle, mixing medications, forgetting to take medicines, and an inhibition to ask for assistance are all common attributes amongst elderly people that contribute to the abuse of prescription medications.
Although this kind of abuse is common in the elderly, it is frequently misdiagnosed by physicians and goes unnoticed by family members. Prescription drug abuse is present in 12% to 15% of elderly individuals who seek medical attention. Health problems related to substance abuse cost Medicare two hundred thirty three million dollars per year in 1989, and probably account for much larger expenditures today. Although 60% of substance abuse is recognized in patients under the age of 60, only 37% is recognized in patients over the age of 60. Physicians often fail to recognize elderly substance abuse for many different reasons.
1. Lack of awareness by the physician
2. Embarrassment by the physician at the idea of suggesting that his/her elderly patient be screened for abuse.
3. Failure to perceive the importance of substance abuse in the elderly
4. The idea that, “he is old, let him have his small pleasure.”
Elderly substance abuse can be divided into to categories, prescription abuse and non-prescription abuse. The elderly population accounts for 14% of our population, they consume as much as 25% of prescription medications taken in this country. Many drugs are inappropriately prescribed for older people and 25% of prescriptions lack appropriate indications for the patient and their illness.
Benzodiazepines (Valium) and narcotics (Librium) are two of the most commonly prescribed drugs of abuse by the elderly. Over the counter sleeping medications are the most common non-prescription drugs abused by the elderly. Like younger patients who abuse prescription drugs, the elder abusers have a high rate of psychiatric problems due to the addiction. Unlike younger addicts though, the elderly patient is more likely to have physical and neurological complications due to the addiction als.
Screening for drug abuse in the elderly can be difficult because most will deny symptoms and usage. Surveys of elderly community based individuals indicate from 17% to 20% are receiving psychotropic medications that are highly addictive. Almost half indicate use beyond the prescribed levels of these medications. Most elderly patients will try and hide inappropriate prescription drug usage by visiting several physicians and obtaining numerous prescriptions for Valium and narcotics. Normally when an elderly patient goes to the doctor they are on so many different kinds of medication that it requires the use of a shopping bag filled with bottles. Most physicians will ask their elderly patient to bring all medications with them on each visit, both prescription and non-prescription.
If the physician finds redundant prescriptions for narcotics, benzodiazepines or sedative type medications then it should be taken for granted that the patient is probably abusing the medications.
Determining whether or not an elderly patient is abusing his/her medications takes a bio-medical approach by the physician. It has to be determined whether the patient has a biological disease, such as depression that is producing the abuse or whether the abuse has produced a biochemical brain disorder such as dementia or delirium. There must be an examination of the medical complications caused by the abuse as well as medical problems that may have been made worse due to the abuse. Psychological distress amongst the elderly can cause addictive behaviors but to fix the medical condition that is causing the distress the physician will need to prescribe the same types of medications that the patient has been abusing.
Elderly patients have a mixture of social and functional dependencies that encourage addictive behaviors. After a certain age, when they are unable to do the social things they have taken for granted and then begin to have problems doing the things we all need to do daily just to function in life it is easy for them to just pop a pill, any old pill, as long as it helps them continue to live independently. This need to remain independent plays a large role in complicating any medical plan that is put into place when it comes to helping an elderly patient who is abusing their medication.
The long-term treatment and management of an elderly patient who has been abusing their medication will include a mixture of medical, psychiatric and family involvement. If the abuse is acute it may require treatment as an inpatient at a drug rehab facility. It will definitely require family intervention and a willingness by family members to monitor the patient’s medications and schedules. There will have to be continued medical assessment of any medical complications caused by the abuse.
The road back to health can be long and filled with anxiety for elderly patients who have found themselves addicted to prescription medications. Combinations of proper medical treatment, counseling and family support will make it a smoother journey back to a healthier lifestyle. One in which they can be alert, functioning and independent without the need to abuse prescription drugs.