Combating Prescription Drug Misuse Among Older Adults

With the increase in the aging population, there's a growing concern over substance misuse, especially prescription drug abuse, among older adults. This issue demands urgent attention and the development of thorough strategies to address it.

The issue begins when older adults, who often have several chronic conditions, are treated by multiple physicians, leading to polypharmacy for some individuals. A 2019 report in U.S. Pharmacist reveals that around 44% of men and 57% of women over 65 consume five or more prescription and/or nonprescription medications weekly.

The situation intensifies as approximately 12% of individuals aged 65 and older are reported to use ten or more prescription and/or nonprescription drugs weekly. According to the American Society of Consultant Pharmacists, adults aged 65 to 69 average 15 prescription medications annually, while those between 80 and 84 years old average 18 prescription medications annually.

In the United States, 13% of the population is aged 65 and older, and interestingly, this demographic accounts for more than one-third of all prescription drug purchases in the country. Elderly individuals are more likely to engage in prolonged or concurrent use of prescribed medications--called prescription drug misuse, driven by diverse medical conditions. Cognitive decline among some elderly patients further raises the risk of improper self-administration of medications.

Additionally, substance abuse within the baby boomer generation is on the rise, further complicating the health challenges that older adults encounter. Key factors contributing to substance use disorders, including the use of illegal drugs among this demographic, encompass drug abuse, prescription medication misuse, mental health services, and the responsibility of various institutions in tackling these problems.

Understanding Drug Abuse in Older Adults

The issue of prescription drug abuse among older people often flies under the radar, overshadowed by misconceptions about addiction primarily affecting younger individuals. Many find it challenging to fathom the idea of older individuals deliberately misusing drugs, often attributing such behaviors to forgetfulness.

Consequently, any adverse effects resulting from drug abuse in older adults might be misconstrued as other health issues or simply dismissed as natural signs of aging. It is crucial to put these misconceptions to rest and recognize the significance of addressing prescription drug abuse among older people.

Prescription Drug Abuse

As you grow older, your body experiences various changes. You may develop increased sensitivity to medications, experience a slowing metabolism, heightened pain, sleep disorders, memory issues, and heightened anxiety.

Your body does not operate as it did in your younger years. These changes may lead to the need for medication prescribed by a medical professional. However, due to these physical changes, older individuals are at a greater risk of harm and complications if medications are not administered correctly.

Elderly individuals may suffer from severe physical pain due to various ailments and require a means to reduce or eradicate this pain. As the symptoms worsen or become unbearable, some elderly patients may take pain relief into their own hands by adjusting their dosage or seeking alternative methods to obtain the medication they believe they require.

Further, prescription drug abuse among older people could be a result of challenges such as high blood pressure, insomnia, monotony, isolation, family problems, or financial struggles. They may also attempt to manipulate dosage levels to cope with the fear of aging or the grief of losing a loved one.

Shadow Over Care: Prescription Drug Abuse in Long-Term Care Facilities

Despite their essential role in managing chronic conditions, prescription medications can become misused within long-term care facilities (LTCFs), posing a significant threat to resident safety and well-being. Evidence paints a concerning picture, highlighting the prevalence and dangers of this issue.

Studies reveal a worrying reality. A 2023 analysis published in the Journal of the American Geriatrics Society reports that 13% of nursing home residents admitted to misusing prescription drugs, including sharing or obtaining them without a prescription. Another study in International Psychogeriatrics (2018) finds that 18% of LTCF residents engaged in "medication-related behaviors of concern," like hoarding or sharing.

Government agencies echo these concerns. 

The U.S. Department of Justice identifies prescription drug diversion in LTCFs as a significant issue involving residents, staff, and even visitors. News articles have shed light on specific cases, documenting instances of residents selling or trading medication and staff diverting drugs for personal use.

The types of abuse vary, including:

• Sharing drugs: This can be unintentional due to confusion or intentional due to addiction or pain management attempts.
• Seeking additional drugs: Residents may exert pressure on staff for more medication, forge prescriptions, or "doctor shop" by visiting multiple doctors.
• Misusing medication: This encompasses taking medication differently than prescribed, using someone else's medication, or seeking intoxication effects.

Factors contributing to this problem are complex. Resident factors like pain, depression, anxiety, and cognitive decline can play a role. Facility factors such as limited access to care, inadequate staff training, and insufficient monitoring can create opportunities for abuse. Ultimately, the consequences can be severe, leading to serious health issues, addiction, falls, and even death. Additionally, medication abuse creates a challenging environment for staff and other residents.

Addressing this issue requires a multi-pronged approach. Families and other loved ones need to be aware of the problem. Prevention is critical, and facilities should implement comprehensive medication management programs. This includes training staff on proper storage, secure medication dispensing, and close monitoring of resident medication use. 

Risk Factors and Increased Vulnerability

The reasons why older adults are more vulnerable to substance abuse are complex. The high occurrence of chronic health conditions in this age group makes them more susceptible. The increased use of prescription drugs due to age-related health issues also raises the risk.

Additionally, social isolation among older individuals can make them more vulnerable to other drugs and alcohol use, as it can lead to a lack of support and increased reliance on substances as a way of coping. 

Recognizing these risk factors is essential for creating specific interventions and support systems to effectively address substance abuse problems in the older adult population.

Here are some of the common factors that present an increased risk of drug abuse in the older age groups:

Multiple Health Problems and Too Many Prescription Drugs

In the United States, it is common for elderly patients to be given multiple medications. According to the CDC, nearly 30% of individuals between the ages of 57 and 85 were regularly taking at least five different prescription drugs in 2018. From 2005 to 2017, there was a significant increase in hospital admissions for individuals aged 65-84 and those 85 and older due to the use of prescription and illicit drugs, with rates rising by 96% and 87% respectively.

Elderly individuals who are prescribed multiple medications often misuse them, frequently combining the drugs with alcohol consumption or other drugs. Various physical, social, or psychological factors can contribute to drug abuse in older patients, increasing their susceptibility to addiction or misuse.

When a medication's efficacy levels off, they may resort to higher doses to alleviate symptoms or introduce another medication into the mix. They may also mistakenly mix up dosages or combine medications that are incompatible and should not be used together, which still constitutes prescription drug abuse.

Decline in Cognitive Function

As baby boomers get older, they may encounter difficulties with their mental faculties. These faculties encompass memory, focus, communication, physical abilities, eyesight, adaptability, organization, decision-making, and critical thinking. If these mental faculties are impaired, carrying out everyday activities like managing medication can become problematic.

Elderly patients may forget if they have already taken their medication and accidentally retake it. They might also take too much because they forgot the right amount. If they take multiple medications, they could mix up the dosages.

Prior Mental Illness

Older adults with mental health issues like depression, anxiety, or mood disorders are at a high risk of abusing prescription drugs. Their emotional struggles put them at an increased risk for substance misuse as they try to treat anxiety or other mental health issues and find relief.

Some may turn to prescription drug use to ease their symptoms and feel better, but this can lead to dependency. Addressing substance abuse and mental health in older adults is crucial for their well-being and to reduce the risks of abusing prescription medicines.

Common Prescription Drugs Abused by Older Adults and Their Risks

Older adults often take different medications that contain highly addictive substances. Opioids and benzodiazepines are two of the most commonly used drugs by the older age groups.

Prescription Opioids

Opioids are powerful pain-relieving drugs that are often prescribed to manage severe pain. Common opioid painkillers include Percocet, Vicodin, and OxyContin. It is crucial to use opioids only as directed by a healthcare professional, as they are highly addictive.

Opioid use disorder can involve:

• Taking more than the prescribed dose.
• Using pain medicine on someone else's prescription.
• Using them for longer than recommended.

Some individuals may also misuse opioids by altering the way they are taken, such as crushing and snorting the pills or combining them with other substances like alcohol.

Abusing opioids can result in drug addiction or dependency and cause serious side effects in users. Elderly patients who abuse opioids may suffer from sedation, nausea, constricted pupils, slurred speech, constipation, euphoria, respiratory depression, analgesia, confusion, itchiness, and impaired judgment.

Benzodiazepines

Benzodiazepines are often prescribed for anxiety, seizures, muscle relaxation, insomnia, and panic attacks. Common benzodiazepine medications include Xanax, Ativan, Valium, and Klonopin.

Users may feel they cannot function without these drugs or may enjoy the effects, leading to dependence with harmful consequences. Known side effects of benzodiazepine abuse include dizziness, lack of coordination, drowsiness, weakness, blurred vision, slurred speech, and even coma.

Over-the-Counter Medications

Additionally, older adults often misuse over-the-counter drugs and dietary supplements, leading to negative impacts on their health rather than improvements. These products are more readily available and may not raise concerns for family members.

Preventing Prescription Drug Abuse Among Older Adults

The National Institute on Drug Abuse reports a rise in prescription drug abuse among individuals in their 50s and early 60s, as they have historically exhibited higher levels of illicit drug use compared to earlier generations.

The Hanley Center's study revealed a staggering 78 percent surge in older adults seeking emergency care due to drug and alcohol misuse from 2006 to 2012. A striking 63 percent of these patients attributed their substance abuse to anxiety and depression. Furthermore, 30 percent cited financial stress as the leading cause, and nearly half admitted to abusing prescription drugs and alcohol.

Prescription drug abuse in elderly adults is a growing concern, necessitating targeted prevention strategies. Several key organizations play a crucial role in addressing and preventing substance abuse in aging baby boomers.

Substance Abuse and Mental Health Services Administration (SAMHSA)

The Substance Abuse and Mental Health Services Administration (SAMHSA) is at the forefront of initiatives aimed at preventing prescription drug abuse among older age groups. Through educational programs, outreach efforts, and the promotion of evidence-based practices, SAMHSA works to raise awareness about the risks associated with substance misuse and offers resources to both healthcare professionals and older individuals to foster a better understanding of prescription drug use.

National Council on Aging (NCOA)

The National Council on Aging (NCOA) is dedicated to enhancing the health and well-being of older adults. In the realm of prescription drug abuse prevention, NCOA focuses on developing community-based programs and resources that address the unique needs of older adults. By promoting healthy aging practices and advocating for accessible healthcare services, NCOA contributes significantly to reducing the prevalence of prescription drug abuse among older adults.

National Institute on Drug Abuse (NIDA)

The National Institute on Drug Abuse (NIDA) conducts extensive research and provides valuable insights into substance abuse prevention and treatment. In the context of older adults, NIDA contributes to understanding risk factors, evidence-based interventions, and developing appropriate prescription drug monitoring programs. 

By disseminating research findings, NIDA plays a pivotal role in shaping policies and practices that aim to prevent prescription drug abuse in the elderly.

Collaborative efforts from organizations like SAMHSA, the National Council on Aging, and the National Institute on Drug Abuse are essential in developing comprehensive strategies to prevent prescription drug abuse among older adults. By combining educational initiatives, community support, and research-driven interventions, we can create a safer and healthier environment for the aging population, mitigating the risks associated with prescription drug misuse.

Treatment and Support for Older Patients

Medical professionals establish safe dosages for patients, and it is crucial to adhere strictly to prescriptions. If there are concerns about an elderly patient misusing prescription drugs, it is imperative to consult a medical professional promptly. Adjusting the dosage or switching to a less addictive or more potent medication may be recommended.

To ensure proper administration, family members or friends should have a record of prescribed medications and their respective dosages for elderly patients. Utilizing a pill organizer can help prevent misuse or abuse of an elderly patient's medication, as well as avoid accidental double dosing by forgetful patients.

Substance Abuse Treatment Options

Effectively tackling serious substance abuse among older adults requires a comprehensive approach, including tailored treatment options such as therapy, counseling, and support groups. By offering a range of interventions, healthcare professionals can better address the specific needs of older individuals struggling with substance abuse.

Group Therapy and Geriatric Medicine

Incorporating group therapy tailored to the unique needs of older adults is a highly effective way to address substance abuse. Group settings create a supportive environment for sharing experiences, challenges, and successes, fostering a sense of community and understanding.

Additionally, integrating geriatric medicine expertise ensures that treatment plans are specifically attuned to the physiological and psychological complexities associated with aging. This holistic approach not only addresses the immediate concerns of former substance use and abuse but also considers the broader context of aging, contributing to more effective and sustainable solutions for elderly patients.

Addressing Prescription Drug Misuse Among Older Adults is Crucial

The misuse of prescription drugs among older adults is a multifaceted issue that demands concerted efforts from individuals, families, health professionals, and societal institutions. Understanding the complexity of this problem is the first step towards developing comprehensive solutions and offering the crucial support needed by older adults grappling with substance abuse. 

Having access to high-quality long-term care services, whether at home or in a facility, can play a crucial role in identifying potential issues early on and even preventing them from arising. Nursing staff are key in ensuring that polypharmacy is avoided by alerting doctors to any multiple drug prescriptions and confirming that all prescribing physicians are informed and coordinated in their approach.

Initiatives to increase awareness, educate on safe medication practices, and foster collaboration across various sectors are vital in building a well-informed and healthier aging population. Additionally, implementing preventive measures, improving access to mental health services, and promoting alternative pain management strategies can significantly mitigate the risks associated with prescription drug abuse. 

By grasping the intricacies of this issue, we can strive to put in place holistic solutions and offer the essential support for older adults dealing with substance abuse. Together, these approaches can help safeguard the well-being of our elderly, ensuring they receive the care and attention they deserve.

Adding Long-Term Care Insurance to your financial plan can safeguard your income and assets against the soaring costs of long-term care while giving you access to the latest advancements in technology and caregiving options. An LTC policy is not just about protecting your finances; it's about ensuring access to the best care available as your needs evolve.