Berks County Medical Society Medical Record Fall 2018 - 31

M e d i c a l R e c o R d F e at u R e

Substance Use Disorder
in Older Adults
by Dr. Ming R. Wang, MD, FASAM, Physician, Caron Treatment Centers

W

hen a 75-year-old presents at an emergency department
with vomiting and dehydration, withdrawal is usually
not at the top of the list for the differential diagnosis.
Nor is substance abuse or withdrawal the first thing a primary care
provider thinks when an older adult patient taking medication
for chronic pain reports sleeping issues or feelings of anxiousness.
Likewise, when an older adult or family member reports
forgetfulness or fall, substance use is not often considered a primary
cause, unless noted by the patient or family. Research, however,
shows that substance use disorder in the older adults -ages 65 and
older-is a growing problem that is often underdiagnosed and,
therefore, undertreated.
Substance Use Disorder, also called addiction, is not the
first thing we think of when we see impairment in older adults.
When monitoring an older adult's health, healthcare professionals
and loved ones may be more attuned to issues such as dementia,
Alzheimer's disease, frailty, loss of balance, and reduced hearing and
sight. Further confusing matters, the symptoms of substance use
disorder may mirror those common diagnoses, as well as the signs of
the aging process in general.
Yet, Substance Use Disorder should be taken into account when
evaluating older adults. The National Council on Alcoholism and
Drug Dependence (NCADD) estimates that there are 2.5 million
American older adults, including nearly half of nursing home
residents, struggling with substance use disorder. Some may have
recently become addicted, while others struggled their entire lives.
Recent data from SAMHSA shows that six to eleven percent of
elderly hospital admissions are a result of alcohol or drug problems
- 14 percent of elderly emergency room admissions, and 20
percent of elderly psychiatric hospital admissions. In fact, seniors
are admitted to hospitals as often for alcohol-related problems as for
heart attacks.
Alcoholism and substance abuse among older adults are not new
problems, but, as noted above, they have largely been underreported
or underdiagnosed for a variety of reasons including co-morbid
conditions that mask underlying substance use disorder. Stigma and
shame also play a large role in patients and families underreporting
or minimizing symptoms. Ageism-or the assumption that these
patients are too old for treatment-also can be a barrier to care.

Loss and Quality of Life
There are numerous life changes that may drive older adults
toward self-medication: retirement, downsizing, failing physical
health, physical pain, and more. Loss and grief are particularly
significant for this population. A study examining alcohol
consumption in recently widowed older men showed those
at the age of 75 were a high-risk group for hazardous alcohol
consumption, as well as a target group for preventative intervention.
At age 75 and above, widows and widowers are retired, so the
loss of a spouse results in a sudden loss of social contact and
companionship simultaneously, making it overwhelmingly stressful.
Older males in particular are deeply affected by the loss of a spouse
because the loss compounds a loss of identity brought on by
retirement.
Losing a spouse or partner can have a devastating impact on an
older adult. Not only have they likely been in that relationship for
a significant portion of their lives, they are typically more prone to
isolation. This is compounded by the loss of mobility, independence,
and activity, all of which have a profound psychological influence.
Known as the Silent Generation and Baby Boomer Generation,
older adults grew up in a culture where mental health issues were
not addressed and there was a tendency to minimize family trauma.
At the same time, self-medicating with alcohol and other substances
was frequently the norm. Many older adults even have memories
of learning to "fix" their father's favorite drink as he returned home
from work. It can be more challenging to share their personal pain
with others because it's counter to what they learned.

The Role of Prescription Drugs
While most older adults are admitted to treatment for abuse of
alcohol, prescription drugs are increasingly an issue. People 65 and
older consume more prescribed and over-the-counter medications
than any other age group in America. They also often take many
medications from different doctors, for different medical issues
concurrently. According to the Substance Abuse and Mental
Health Services Administration (SAMHSA), 30 percent of people
ages 57 to 85 take at least five prescriptions, increasing the risk of
unintended drug interactions and dependency.
continued on next page >
FALL 2018

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Berks County Medical Society Medical Record Fall 2018

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