SUBSTANCE USE DISORDER [SUD] / ADDICTION IN THE ELDERLY
Advances in medicine have succeeded in enhancing human longevity.
However, with longevity but not longer professional working years, people are looking at about 20-30 years of post -retirement life which is bereft of the professional working life they were used to.
Though the older adult population shows lesser prevalence of substance use in respect to the general population, still the proportion of these older adults becoming at risk for hazardous drinking, abusing prescription medication and illicit drugs is becoming higher.
Alcohol use still remains the highest used substance amongst older adults.
Illicit drugs- use mainly cannabis use is seen more in older adults than cocaine, or methamphetamine or other substances.
With the medical marijuana being used for relief of pain and other ailments there is an increased risk of addictions to the same and health hazards in elderly individuals.
Prescription medication addictions are on the rise whether medications for pain, opioids, or sleep aids and sedatives like benzodiazepines which might be mis prescribed, misused, overprescribed etc.
OLDER ADULTS AND SUSBTANCES- VULNERABILITIES
The process of aging itself presents with risk factors regarding even minimal substance use and abuse based on the specific clinical manifestations like age, medical co- morbidities or ailments , current medications being taken, current ailments or past health history etc.
Understanding individual substance use and abuse hazards gives a better understanding as to how to tackle the situations.
- Alcohol - Aging leads to loss of muscle mass, muscle tone, increased body fat, bone degeneration, brain changes, total body water content reduces, the ability of the brain to digest alcohol is affected, the blood brain barrier permeability increases and receptivity of brain neurons to alcohol increases.
Due to these factors , older adults experience increased blood alcohol concentrations and increased physical damage due to alcohol. The same quantum of alcohol that the individual drank when younger if continued into older ages , will cause more damage and rapid deterioration in physical and mental or psychological health of the individual. Dementias, alcohol induced long term brain damage, osteoporosis, neurological disorders, rapid liver disorders all exponentially set in and increase in effects earlier and faster in older adults abusing alcohol.
- Prescription Medication and Illicit Drugs - The same physiological changes that age brings in causes more damage and sensitivities to most licit and illicit drugs. For example Benzodiazepines that are fat soluble will have prolonged and dangerous sedative effects in older adults as they have a higher fat mass than muscle mass.
Older adults are seen to have a tendency to go doctor shoping, resulting in multiple prescriptions. Add alcohol or any illicit drug to the mix and one cannot even begin to assess the various drug interactions and the resulting damage to the body and brain. Older adults also have a tendency to ask their peers for medical advice and medications advice and borrow medicines from their friends to try out which might interact dangerously with the medications that they are already taking.
The increased use of marijuana which causes increase in heart rate, respiratory rate when used by elderly individuals have known to put them at an increased risk of getting a heart attack soon after smoking a joint or consuming the marijuana thus increasing mortality rates.
- Sex - males more prone to alcohol use and females to prescription medication use
- Physical health – consuming alcohol or pain medication to reduce pain. Getting better sleep.
- Psychological - Isolation, loneliness, the empty nest syndrome , anxieties that come with old age, depression which is undiagnosed or unlooked at , all these tend the individual to using prescription medications or resorting to or justifying use of alcohol.
Sleep disorders or reduced sleep patterns with age affect the psyche of the individual and someone who is used to drinking uses that as an excuse to increase consumption and add sedatives to the mix.
Transitions in life from work to retirement to post retirement, care giving to a long term ill spouse or person in the family all add to use abuse and addictive use of substances.
The Assessment is difficult – as there are many overlapping co morbidities that mask the abuse of substances. Also physicians should have a non -stigmatizing approach to ask for the history of substance use and abuse extensively to understand the psycho-social-physical factors that come into play.
Some indicators of substance use
- Physical - Poor hygiene, history of frequent falls, non receiving phone calls , excessive calls and talking vociferously, unusual tolerance response to alcohol and medications and anaesthetics, NutrItional deficits, blackouts, sensory affectations , Chronic pain, seizures without reason.
- Cognitive symptoms - Disorientation, memory loss, overall cognitive damage, sudden indecisiveness
- Psychiatric, Psychological - Sudden sleep disturbances, insomnia, severe anxiety, depression, mood swings that are in explicable
- Social - Problems at the level of family, social, financial instability, Social isolation, loneliness, Medications getting over early, borrowing medications from friends etc.
The Michigan Alcohol Screening Test – Geriatric version is one of the tests to screen in geriatric age group.
Tailor made treatment programs that are residential in a non -judgmental , accepting, loving , comfortable, therapeutic environment is essential for the elderly age group. The physical and psychological needs and issues are addressed, Denials are broken through with care-frontational, non -threatening approaches.
Counseling, Meditation, introspective writing, to deal with the emotional unmanagEabilities. Yoga , Tai chi and other physical activities to maintain a physical , physiological and mental balance and build muscle tone.
At Anatta we offer all this and treat them with dignity and love , enabling them to be comfortable with themselves, learn social skills, be okay with being alone and not be lonely , and at the same time discover and indulge in new hobbies, activities, safe social engagements or volunteering where the wisdom of their age can be utilized . This to make them productive individuals once again, re- gaining self- respect and a sense of dignity.