Audio Journal

The Elderly, the Forgotten Victims of Addiction

For 20 years, my mother in law had a great relationship with the man she fell in love with when she met him on a cruise at age 74.  But things changed dramatically a few years ago.  As he aged, he experienced a number of health issues that plague so many of the elderly.  His joints started to fail, his health declined, and he began to experience persistent pain.  Enter a less than competent doctor who managed his health issues with only one strategy, prescribe opioids.

It didn't take long for the 90-year old to become addicted, needing more and more of the medications to manage his pain so he could get through the day, despite the fact that those medications became less effective over time.  He was now addicted, and along with many other addicts, his loving and caring personality changed.  He became angry, irritable, blaming and abusive.  He engaged in the same drug-seeking behavior we would normally associate with a teenager. Ultimately the relationship ended when my mother in law had enough and now, she's spending her final years alone.

Is this story unique among the elderly?  Unfortunately, it is not. It is estimated that 17% of individuals over age 65 struggle with the disease of addiction.  Perhaps they've been struggling with addiction for years, but more often they have developed the disease after being over prescribed pain medication without a long-term plan to transition from pills to deal with the underlying causes of the pain.

The fact is that addiction among the elderly goes unrecognized and undiagnosed robbing them of getting the help that they need.  This trend is made worse because family and medical professionals are not informed about the risks of addiction in the elderly, office visits to the doctor are often hurried and healthcare providers often overlook substance abuse among the elderly. Not recognizing addiction in the elderly is made worse because they often have medical or behavioral disorders that mimic symptoms of substance abuse, such as depression, diabetes, or dementia.

There are certain times in an elderly person's life that make them more vulnerable for developing addiction.  Here are a few.

People retire.  You get up and go to work daily, have a purpose, and have structure in your life.  Then you retire, have lots of time on your hands, miss your work friends, and have a hard time adjusting.  Stress around making that change often motivates individuals to turn to alcohol to cope.   Not to mention that many of the elderly haven't planned well enough so the loss of income and financial stress also becomes triggering events.

The person has experienced the death of a family member, their pet or close friends.  As we age, the people that have been important in our lives start to die off.  One loses their spouse, their best friend, or their brothers or sisters.  Grief and depression set in and substances became a coping mechanism.

As we get older, our sleep patterns change.  I remember that my dad when he aged, he began to wake up in the middle of the night, move to the couch and find it hard to go back to bed.  With changing sleep patterns, the elderly may seek relief in prescription pills.

Being relocated or placed in a nursing home is often a catalyst for being overprescribed.  Audit the medications a nursing home patient takes, and you might be astounded at how many mood stabilizers, pain pills, sleeping pills and anti-anxiety drugs are prescribed so these individuals become more manageable.  The downside consequence is that they become addicted and face the consequences that come along with the disease.

The people most at risk are those facing mental or physical declines.  My mother in law's husband had joint problems, needed hip replacement and experienced chronic pain.  My mother in law had osteoporosis and multiple trips to the hospital with broken bones.  She was on a long-term diet of opioids that had totally lost their effectiveness.

Drug and alcohol abuse among the elderly is particularly dangerous because senior citizens face more deteriorating effects brought on by sustained substance abuse. As we age and reach 65, we have a decreased ability to metabolize drugs or alcohol along with increased brain sensitivity to them. This makes it dangerous for seniors to use drugs or alcohol at all, even if the person isn't addicted.

Prescription benzos, such as Valium, that are used to treat anxiety, pain or insomnia, are some of the most dangerous prescription drugs for seniors. Doctors love prescribing them even though they are highly addictive. The rate of senior citizens addicted to benzos has increased every year.

So, now that you know that we have a real problem with our senior citizens, what should we do about it?  The first step is to recognize if there is a problem and here are some clues.

• Watch out for slurred speech
• Look for physical changes such as weight loss, decreased appetite and unkempt appearance or poor hygiene.
• Notice an increase in their drinking habits.  If they normally had an occasional glass of wine, but now drink daily, that's a warning sign.
• Watch for repeated requests to go to the doctor without a corresponding medical reason to do so.  My father in law was doctor shopping for pain pills.
• Notice repeated falls or blackouts.  That may not be aging, but substance abuse.
• Think about behavior you would spot in your teens as being problematic that may be characteristic of drug seeking - lying, hiding, anger or deflection.
• Watch for other mental issues such as anxiety or depression.

Now that you suspect substance abuse or addition, what should you do?   This is different than working with a teenager that you have control over, so you have to manage it differently.

First, attend doctors' meetings with your family member.  Challenge the doctor on their pain management strategies and propensity to prescribe.  Ask for strategies that get to the root of the problem vs. just masking it.

If your loved one is in a nursing home or assisted living, ask for a medication review.  You may be shocked at how many drugs they are on and what is just not necessary.

Be loving, but direct with your loved one if you suspect a problem. Tell them what you are observing and collaborate to help them address the problem.  Don't be judgmental and prepare that they may be resistant to the conversation but be persistent.

Consider treatment.  Research indicates that older people do just as well in addiction treatment as do younger ones.  A recovery strategy for the elderly may just help them refocus on find purpose in their lives, giving back, and being less disconnected and unhappy.

Takeaway

In the midst of the Opioid Crisis, let's not forget that we owe it to our seniors to pay attention, recognize that they are vulnerable, and we should take steps to help them live a pain free, addiction free and happier life.