Substance Use

Many people are not aware of the age-related changes that make the human body more vulnerable to the effects of substances. For the purposes of this guidebook, “substances” include alcohol, drugs, and medications, both prescription and over-the-counter.

Problems with alcohol and psychotropic medications (medications that target brain function) are the most common types of substance use problems seen in older adults. Substance misuse and abuse among older adults is associated with a high rate of falls, delirium, institutionalization, and mortality. In most cases, the problems are unintentional and preventable.

Medications

As we age, our bodies experience changes (i.e. enzyme, metabolic and body composition changes) that impact the absorption, processing and excretion of medications. Some drugs may actually have the opposite effect in an older body than they do in a younger body. Unfortunately, most drug testing is done on younger people and dosage recommendations are often based on the effects measured in younger bodies.

Approximately 75% of people over the age of 65 take a prescription medication. The average number of medications an older adult may be using at any given time is five. More than half of medications commonly prescribed to older adults have some sedating side effects.

Given these facts and the knowledge that older adult body systems are changing, it is easier for us to understand the ease with which an older adult can fall victim to the problems of negative medication effects. Unfortunately, the cost of medications and certain access issues results in many people skipping doses, sharing medications or otherwise altering a prescription. This can be very dangerous and it can worsen illnesses. If you cannot take a medication as prescribed, tell your health care professional and be honest about the reasons — there might be another way to meet your medication needs.

Older adults are the greatest consumers of over-the-counter (OTC) medications (antacids, cold remedies, laxatives, sleep aids, etc.) and “nutriceuticals” (herbals, dietary supplements, vitamins, etc) accounting for 30% of all OTC sales. A common myth of these substances is that they are “safe” simply because they are readily available and not subject to the same FDA (Federal Drug Administration) standards. In fact, OTC’s and nutriceuticals can have significant side effects and negative interactions with other drugs. Some can be habit forming and some can be dangerous to individuals with dementia and certain illnesses.

Whatever the drug, dangerous substance misuse by older adults in our culture goes under-estimated, under-identified, under-diagnosed, and under-treated. This happens for a many of reasons including confusion of symptoms with other problems, lack of education, denial, ageism, myths, stigma, and limited research and data.

Anyone who has been on a long-term medication should have the medication and dosage reviewed. The types of medications or dosage strength of long term medications may need to be changed with age and onset of other illnesses.

Responsible medication use includes some of the following:

• Informing doctor of all prescription and non-prescription substances you take, including the amount of alcohol you drink
• Follow the directions on the label
• Know what time of day, and how many times per day to take a medication
• Know if you should take the medication with food or without
• Ask if any of your medications might react with other prescriptions, over-the-counter medications, vitamins, alcohol or foods
• Keep track of any side effects you experience and report these to your health care provider
• Review all medications with your health care provider every six to twelve months to evaluate their necessity, therapeutic effect and dose appropriateness

Alcohol

Alcohol is a culturally acceptable drug that is commonly overused and misused by adults to cope with difficult life changes. It can be tricky to make distinctions along the continuum of misuse, abuse and addiction of alcohol or other drugs. However, when people use a substance to change their mood, cope with problems or feel different, they are at risk for abuse and addiction. We know that alcoholism and addiction are diseases – not weaknesses or conditions that can be willed away. Addiction requires treatment.

The consequences of substance abuse in later life are much greater than in younger years, and if the abuse continues, all other problems (symptoms of illnesses, trouble in relationships, trouble with sleeping, changing moods, etc.) are likely to become more acute.

The good news is that older adults have a higher recovery rate than any other group.

If you have the opportunity to talk with an older adult about alcohol/substance use or addiction, assure them that they have a disease for which there is treatment. Be supportive and not judgmental. Suggest that they talk to their doctor and also contact appropriate support groups to obtain information, assistance and support.

Education

Our most powerful weapon against substance abuse problems is education.

Know these facts:

• Alcoholism is a disease. Addiction is a disease. People who are addicted are not “bad” people who need to get “good”, they are sick people who need to get well.
• Denial is a strong force and also a definite symptom of the disease of addiction
• Intervention, withdrawal and after-care for older adults require careful planning due to the sensitive physical nature of the aged body system, and the need to mobilize effective support.

Substance use becomes problematic when:

• An individual denies that their use of the substance is causing problems
• It interferes with a person’s ability to function, perform tasks or carry out responsibilities
• Relationships are disrupted or destroyed
• It causes physical, cognitive, behavioral or mood problems