Substance Abuse in the ElderlThe focus of this paper will be pointed on the subject of substance abuse in the elderly community. Things that will be included in the paper include the prevalence of substance abuse, how to identify someone who has problems with substance abuse, interventions, and solutions or treatments for people that struggle with substance abuse. Substance abuse is substantially different in the elderly community than in younger adults. As people get older, their bodies do not metabolize alcohol as quickly as a younger adult’s body would. Therefore, older adults have increased sensitivity to substances such as alcohol, making the elderly community at higher risk for substance abuse.
Some of the most common over-the-counter and prescription medications misused by older adults are painkillers, antianxiety drugs, sleeping pills, diet aids, and decongestants. Another common one is antipsychotic drugs. Antipsychotic drugs are of specific concern because the continuous use of these can lead to dangerous symptoms or side effects. Older adults also tend to misuse alcohol, a lot of the time without them even knowing it. This proposes a danger for older adults because oftentimes they are on multiple medications for different problems going on, more than likely from a result of the normal aging process. The use/overuse of alcohol can create unsafe medication interactions, increase falls, depression, confusion, and premature mortality (Friedman & Steinhagen, 2008).
The signs and symptoms of abuse of alcohol in an older adult are often mirror or are very similar to other commonly seen medical conditions in older adults and majority of the time are falsely believed to be a part of the normal aging process. These symptoms include confusion, depression, sleep problems, memory problems, fatigue, irritability, and anxiety. The signs and symptoms of over-the-counter and/or prescription medication misuse include loss of short-term memory, irritability, mood changes, lack of energy and concentration, and a general loss of interest (Friedman & Steinhagen, 2008).
There was a study done in Miami Valley Hospital in Dayton, a verified Level 1trauma center, over a 60-month period. During this time, blood alcohol content as well as urine drug screens were routinely performed on trauma patients. The substances tested in the urine drug screens were benzodiazepines, amphetamines, barbiturates, amphetamines, phencyclidine, cocaine, opiates, tricyclic antidepressants, and tetrahydrocannabinol (marijuana) (Ekeh et al., 2014).
Of the patients over sixty-five years old that were tested, sixty-point nine percent of the patients tested were males and tested positive for the presence of alcohol and/or drugs. Thirty-nine-point one percent of the patients tested were female and tested positive for the presence of alcohol and/or drugs. Of the patients over sixty-five years old that had their blood alcohol levels tested, eleven-point one percent of them tested positive, which means it was greater than eighty mg/dL. Of the patients over sixty-five years old who had their urine tested for the presence of drugs, ninety-two-point nine percent tested positive for the presence of opiates, two point five percent tested positive for the presence of marijuana, three-point three percent tested positive for cocaine, and one point two percent tested positive for amphetamines (Ekeh et al., 2014).
As mentioned previously, elderly people are more likely to experience negative effects with smaller amounts of alcohol consumption than younger adults. There are multiple reasons as to why the use of alcohol can have negative affects the elderly more so than the younger adult. One reason is that there is an increased likelihood of pre-existing chronic illnesses and/or conditions that may be aggravated by the use of alcohol. Older adults also have decreased levels of water in their body, which allows higher levels of blood alcohol when consuming alcohol. The use of alcohol in the elderly can be a causative factor of more than 60 medical conditions, including cancerous conditions of the liver, mouth, throat and stomach (Green, 2014).
Substance abuse by older adults also includes the use of illicit drugs. The effects of the drug on the person using it vary widely depending on the amount being used, the quality of the drug, the frequency of use, and the use of other drugs or substances along with the illicit drug. The consequences of the use of various types of illicit drugs on the bodies of elderly adults are still unknown, and there are concerns that as the usage increases in this population with time, that healthcare facilities may not be prepared to aid in the treatment of the long-term consequences in the older adult that may come with the overuse of illicit drugs (Green, 2014).
Another type of substance abuse that commonly occurs in the elderly population is poly-pharmaceutical abuse. It has proven difficult to pinpoint specific consequences of poly-pharmaceutical abuse, especially when one does not know exactly what medications are being taken and how much of the medication is being consumed. Green (2014) uses an example of over-the-counter products that contain paracetamol, such as throat medicine, cough medicine, mucus relief medicine, flu and cold medicine, etc. These types of medications are easily accessible to the general population. Although the dosage and administration instructions are stated on the box, it is not always guaranteed that the adult taking the medication will follow those instructions. Older adults also may not be able to clearly read the small print on the medication box. This may lead to taking too much medication. Overdosing on paracetamol can cause liver damage and/or liver failure for many older adults. There is also a risk that the adult taking the medication will already be on other medications that could possible react with paracetamol. Substance abuse can also affect the psychological and sociological state of the older adult that is taking the medication. Some changes in their psychological and sociological state may be random changes in their temper, on continuous irritability, abnormal confusion, issues with memory, depression, and absence of personal hygiene (Green, 2014).
Substance abuse in the elderly can have multiple negative effects on those involved in the elderly person’s life such as family members, children, and significant others. If the elderly adult who is abusing a substance is living with a significant other, then the significant other can often feel like it is their fault, and that they are the reason their partner is abusing substances. It could also make the significant other feel like they are not a good enough partner. The significant other being affected could feel like they have to hide their partner’s substance abuse problem from the rest of the family also, instead of reaching out for help. If the elderly adult abusing substances has children, it can affect them too. The children of the adult may feel responsible for fixing the problem, adding extra responsibilities and stress into their life. Altogether, families with an older adult with a substance abuse problem are more than likely going to experience feelings of frustration, anger, fear, and embarrassment (Ligon, 2013).
Sam Smith is a sixty-five-year-old Caucasian male is married to Sarah, a sixty-four-year-old Caucasian woman. Together they have two adult children Brian and Amelia. Sam has been retired for two years now and does not have many hobbies besides fixing things around the house and watching television. Sam and Sarah appear to be in a very solid relationship, married and living in the same home for forty years. But, Sarah is worried about Sam because she has noticed in the past couple of months that Sam does not come to bed at night, and that he will choose to sleep in a different room. She also notices that Sam has not been communicating as much with her anymore.
On a Thursday afternoon, Sam Smith comes into the emergency department with his wife complaining that he had just fell down to two steps off of his front porch while going down them, and he thinks he broke his wrist. Sam stated that he was feeling a little dizzy, but figured it was because he had gotten up too fast from his chair. Sam appears alert and oriented upon assessment. His wife reported that Sam has just recently lost his older brother to lung cancer a couple of weeks ago, and has been increasing his alcohol intake to help cope with the situation. Sam’s wife stated that Sam drinks about seven to ten cans of beer a day now, and had about three beers today before he fell and hurt his wrist. Sam’s wife also reported several periods of amnesia for recent events within the past two weeks, increasing argumentativeness and absence from work, increased periods of sleeping throughout the day, and that “he’s just not acting like himself lately.” When tested, Sam had a blood alcohol level of zero point one three.
In the assessment of this patient, a substance abuse screening should be included. The CAGE substance abuse screening tool is easy to use and includes four questions: 1. Have you ever tried to cut down on the amount that you are drinking? 2. Does others asking you about your drinking make you annoyed? 3. Do you ever have feelings of guilt about drinking? 4. Do you ever drink alcohol in the morning to use it as an “eye-opener?” If the person being screened answers yes to any of the CAGE questions, further exploring of their use of alcohol should be done (Addiction Resource, 2015).
Treatment options for older adults to treat substance abuse include a variety, including patient education, preventative services, family support, a medical detox, and an inpatient or outpatient treatment. The patient should be educated on the increased risk of the older adult population for combining the misuse of alcohol with their daily prescription drugs, and what effects that can have. If the older adult is taking multiple prescription medications, they should be educated on the helpful effect of writing down all of the specific doses and administration directions in large letters on paper, and putting it somewhere where they can see it frequently, like on the refrigerator. Another treatment option to try for substance abuse is cognitive-behavioral therapy. This is a type of psychotherapy that allows the patient to become more aware of the way they think, and what leads them to drink alcohol or use other substances. That way, when those thoughts arise outside of therapy, they will be able to identify them and find ways to not give into them (Addiction Resource, 2015).
There are also programs such as Alcoholic Anonymous, which uses twelve steps as the approach, and has regular anonymous meetings with other people of all ages who also struggle with the use of alcohol. Families also play a very important role in supporting the elderly person in their family and helping them prevent relapse. Family members of the older adult affected should really focus on communicating with that adult in an empathetic, respectful way (Addiction Resource, 2015).
Substance abuse in the elderly population is not a very popular topic of discussion. When people think of substance abuse, they think of substance abuse in the younger population, because that is where the problem is more profound. Therefore, substance abuse in the elderly population is often overlooked. A lot of the time substance abuse in the elderly population is overlooked simply because people do not think older adults would have problems with abusing alcohol or illicit drugs. Also, the symptoms of substance abuse in the elderly population such as confusion, depression, sleep problems, memory problems, fatigue, irritability, etc. are often looked over and seen as normal side effects of aging. Not only is substance abuse in the elderly population overlooked by younger adults, but it is also overlooked by the elderly population themselves. A lot of older adults are not aware that they are at increased risk for substance abuse, because of the effects of aging on their metabolism and the way it affects the way they metabolize alcohol and drugs, making them more sensitive to smaller amounts. Older adults are also at higher risk for substance abuse because of the increased amount of medications they are on for multiple problems usually caused by the normal aging process. Not only does substance abuse in the elderly have negative effects on the elderly themselves, but it also has an effect on the people around them such as their significant others, children, etc. It can cause tension and put a strain on families and relationships.
This being said, substance abuse in the elderly population should be discussed more. The fact that the subject is overlooked quite often puts the elderly population even more at risk for developing negative side effects of substance abuse, such dizziness that can cause falls. Older adults should also be educated on their risk of substance abuse, and how it can happen without them even knowing it. More people need to be aware that substance abuse in the elderly population is a very real thing that is currently happening and should not be ignored.
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