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Drug problems afflict seniors
Grandma may look serene as she dozes in her rocking chair, but her drowsiness could be a side-effect of something other than old age.
Apparent tranquility could actually be lethargy brought on by her taking the wrong medications, by her improperly mixing prescriptions, by her aging body's inability to metabolize the drugs or by alcohol abuse.
National research on senior citizen health suggests that 17 percent of adults age 60 and older misuse or abuse prescription drugs, over-the-counter medication and/or alcohol.
While the percentage might not seem high, experts on aging and substance abuse are warning that drug awareness among the elderly — the most medicated age group — is largely undetected and spreading in large part because of the elderly themselves and unaware medical health providers.
In Utah, there is blunt acknowledgement that little has been done to understand, track or even tackle the problem of senior drug misuse and abuse on a wide scale.
"The field is trying to catch up with the demand," said Barbara Sullivan, associate director of the Utah Addiction Center. "It is a new frontier because we have not had that many senior citizens seeking treatmentStatistics compiled by the state Division of Mental Health and Substance Abuse show few admissions to drug addiction treatment centers of people age 66 and over.
While Utahns between 26 and 35 years old are most likely to seek such treatment — there were 5,155 treatment admissions in 2003 in that age group — the number dwindles to just 47 admissions for those older than 66.
Experts agree the low number isn't an indication of a small problem but more likely the result of a number of other factors — people "aging" out of their addiction, the system being dominated by criminal justice referrals, addiction being a largely unrecognized and therefore largely unreported problem in the senior population.
What those numbers ultimately reveal to Sullivan is a dearth of information on how to treat senior addicts.
"I am not sure there is much expertise out there on what type of treatment we need to provide senior citizens," she said. "It is an area where substance abuse professionals need to become more proficient. . . . We really don't have those kind of services available."
Aging and substance abuse professionals in Utah do predict that as the coming proliferation of baby boomers embrace their so-called golden years, the need to offer treatment to older adults will escalate.
"They are going to bring their addiction problems right along with them," said Pat Fleming, director of Salt Lake County's Division of Substance Abuse. "The conjecture, too, is that we will be dealing with a more permissive, more willing-to-experiment group of seniors that we have never dealt with before."
Fleming notes that baby boomers are likely more used to and even more willing to self-medicate than seniors today. Boomers were in college when it was the norm for students cramming for an exam to visit the campus nurse to pick up some "cross tops" — or stimulants — to get them through a long night of study.
Ginette Pepper, a Salt Lake doctor who specializes in geriatrics and nurse pharmacology, agrees.
"There truly has been almost nothing done about the elderly abusing alcohol and drugs," she said. "There has not been adequate attention given to the problem."
Both Sullivan and Pepper believe it is important to stress the difference between "abuse" of prescription drugs and "misuse" of medication.
While seniors may self-medicate with alcohol to cope with isolation or depression, it is more common for older Americans to get unwittingly hooked on tranquilizers and sleeping pills or to suffer adverse physical and mental effects by misusing prescriptions.
Much more often than not, according to state and national research, the basic fact that the elderly are different physiologically often isn't factored into their medication and health care regimen:
- The aging process compromises a senior's ability to metabolize drugs and alcohol, reducing tolerance levels and at what point it becomes toxic to a patient.
Barbara Ripley, a caseworker with the state's Adult Protective Services, says overmedicating, or mixing meds, can lead to a "toxic dump" or overdose.
"There is a tendency for the drugs to build up in the liver, Ripley said. "They build up and build up over time because they don't have the ability to eliminate the drug from their system."
- Medications are often prescribed in dosages that are normal for a healthy young adult similar in weight and size to an elderly patient.
- Drug-related problems often get overlooked because the symptoms are incorrectly attributed to changes incident to aging.
Ripley, who spends the bulk of her time checking on residents in nursing homes, said the most common drugs she sees misused and overprescribed among seniors are benzodiazepines — tranquilizers used for anxiety, depression and insomnia.
While tranquilizers may be initially prescribed to blunt the grief due to the loss of a spouse, their addictive nature can lead to misuse. Misuse or abuse can cause forgetfulness, excessive sleepiness, a zombielike effect or falls and stumbling. Ironically, the same characteristics are often associated with getting older.
"It can mimic dementia," Sullivan said, adding that the symptoms can lead family members to take drastic but unnecessary measures such as premature institutionalization.
Ripley said she has seen the ill-effects of overmedication play out in nursing homes too often. One man was semi-comatose when she visited him.
"He was almost in a vegetative state," she said. "He was non-verbal, couldn't keep his eyes open, couldn't sit up and wasn't eating."
The number of his medications was not only astounding, she said, the man was being treated for asthma even though he didn't have it.
Pepper, who is the Colby-endowed chair in gerontologic nursing at the University of Utah's College of Nursing, points to a list formulated by several physicians in the early '90s identifying 28 classes of medications inappropriate for older patients.
Dr. Mark Beers and several other specialists in geriatric drug therapy developed the list that was used in a subsequent Duke University study determining that 20 percent of people over 65 might be taking inappropriate drugs.
Anti-depressants comprised 40 percent of the prescriptions, and more than 15 percent of the population was taking two or more drugs on Beers' list.
Local experts say seniors take an average of 11 medications per day; it is not uncommon for seniors to take as many as 20 types on a daily basis.
Dealing with that volume of pills can easily lead to confusion, with seniors inadvertently taking the wrong dosage at the wrong time.
That problem is compounded by the fact that pharmaceutical companies often do not use seniors in their drug trials of new medications, leaving medical professionals with little information about possible adverse effects or definite advice for an elderly patient.
"The geriatric population has become the guinea pigs for pharmaceutical companies," Ripley said.
While it is widely acknowledged there is little known about senior drug abuse, some steps are being taken to address the problem, especially in light of the anticipated surge in the population.
Utah's 65 and older crowd increased by 8.6 percent in four years.
Nationally, those 85 and older are the fastest-growing age group; Utah is double that rate. Census figures from 2000 show that Utah is the sixth fastest-growing state in the country for its 65-and-older population.
On a national front, the Substance Abuse and Mental Health Services Administration has teamed with the Administration on Aging in an initiative that in part will help states develop a strategy for tackling drug misuse and abuse among seniors.
Locally, Salt Lake County's Area Agency on Aging is teaming up with substance abuse prevention workers to educate seniors.
"Internally, we are in the process of planning what we need to do to provide services in this area," Fleming said. "It is a problem that is only going to continue to grow."
Senior Citizen Aticles | Drug Problems
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