Berks County Medical Society Medical Record Fall 2018 - 32

Substance Use Disorder in Older Adults
continued from page 31
Older adults are particularly at risk for prescription drug abuse because they are more likely
to take medications to address co-occurring such as anxiety and depression and age-related
conditions including chronic pain. These medications, which have a high potential for addiction,
include:
* Opioids for pain management (oxycodone, fentanyl, and morphine)
* Stimulants to enhance brain activity (amphetamines and methylphenidate)
* Benzodiazepines to treat anxiety and insomnia (diazepam, chlordiazepoxide HCI,
and alprazolam)
In addition to the increased availability and accessibility of prescription drugs, as a person
gets older, their body changes. These changes can impact the way they absorb and filter medicine,
making them more vulnerable to addiction than a younger adult.
In our experience treating older adults at Caron, we recognize that patients are not taking
these medications for euphoria or to "get high." Patients primarily use and abuse prescription
medications to feel better. With many prescription medications such as opioids for pain and
benzodiazepines for anxiety, the medication intended to make them feel better is now making
them sick.

Signs of Addiction

Complications of SUD
* Sleep complications
* Health conditions
* Decline in ADL's
* Unexplained bruises/burns
* Fall risk

Family members, caretakers and health care providers frequently mistake the signs of
substance abuse for other physical and mental disorders associated with age. Older adults are
also more likely and able to hide their substance abuse as they are often retired and not prone
to getting in trouble with the law, so there are seemingly less negative consequences to their
behavior.
Signs of possible substance misuse among older adults may include physical symptoms such
as injuries, increased tolerance to medication, blackouts, and cognitive impairment. Psychiatric
symptoms that may suggest a problem with substance misuse include sleep disturbances, anxiety,
depression, and mood swings. Other behaviors include use of the medicine outside of the
doctor's instructions; seeking a prescription from multiple doctors or filling an order at multiple
pharmacies; behavior changes, such as becoming angrier or withdrawing from everyday activities;
defensive about and making excuses for taking the medicine or hiding the medication.

* Medication interactions

Older adults more vulnerable to effects of alcohol and medications

* Vulnerability

* Increased risks of co-morbid diseases

* Memory loss, dementia,
delirium

* Increased risks of harmful drug interactions, injuries, depression, cognitive issues, liver
and cardiovascular diseases
* Increased fall risks leading to bone fractures, internal bleeding and head injury

* Malnutrition

* Poor cognition interfere with ability to recall use history

* Incontinence

* Withdrawal management challenges

* Lack of social interaction
* Vision problems
* Cognitive decline
* Hearing problems
* Impotence

32

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The abuse of prescription drugs impacts the overall health of older adults in several ways.
Patients increase their chances of falling or having an accident, and they can worsen neurological,
respiratory, and other age-related conditions. Overall, patients who abuse prescription drugs tend
to have higher rates of morbidity. The heart, liver, kidney, central nervous system, including the
brain, all react differently to medications and alcohol in advanced age-and mixing the two may
bring on adverse reactions. Older adults also do not metabolize substances as they did at younger
ages, and the body takes longer to cleanse itself of alcohol and medication. Withdrawal is also
significantly more dangerous for an older adult. In this population, their substance use may
have started younger, and therefore, the complications-such as cardiovascular events and organ
malfunctions-appear to be more severe than the general population.


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Berks County Medical Society Medical Record Fall 2018

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