Booze, pills, over medicating, heavy drinking. Seventeen percent of retirees misuse alcohol and prescription drugs.
What’s going on? Is this a case of hedonistic, self destructive seniors partying hardy day after day or is there another explanation?
Although there are only a handful of researchers investigating substance use disorder (SUD) in older adults, there is nevertheless a consensus that SUDs are being perpetuated by a quartet of interactive factors.
First and foremost is a lack of awareness on the part of seniors about how their bodies and metabolism changes over time. This is compounded by a lack of information to help assist medical care givers on how to better identify SUD’s in seniors.
Add a lack of cross consultation between a patient's various prescribing physicians, resulting in the unintentional toxic combination of drugs, and top it all off with a lack of treatment facilities and resources that specialize in senior SUDs and you pretty much have the whole enchilada.
As a person ages, the percentage of total water and lean body mass decreases, which makes it harder to metabolize alcohol. At the same time the amount of body fat, which stores alcohol, increases. The liver processes alcohol more slowly, the gastrointestinal tract also experiences a reduction in its metabolism of alcohol, while receptors in the brain that are sensitive to alcohol increase.
As a result, older adults have the highest blood alcohol concentrations of all age groups, meaning they can become inebriated faster and longer by imbibing far less alcohol than they ever did in their earlier years.
Seniors process the two most prescribed classes of prescription drugs — benzodiazepines and opiates — in a very slow manner, allowing these drugs to remain in and act on their bodies for a much longer period of time. These residual amounts then combine with a senior's daily dose of the medication to produce dangerously high levels of sedation lasting for much longer than medically recommended.
Additionally, because many retirees experience a decrease in body weight as they age, the typical recommended adult dose of a medication, particularly a sedative, may simply be far too high, causing overmedication complications.
Shaking hands, forgetfulness, impaired balance, loss of weight, slurred speech, all of these SUD symptoms can be easily considered the signs of aging and diagnosed as such if the patient is not forthright. For many physicians, who spend no more than 15 minutes per patient, it is very easy for them to be deceived and to continue to prescribe medications they believe will benefit their patient.
Without cross consultation between all of a patient's physicians, who are prescribing medications, the possibility of a toxic drug combo is real. Over a third of 65-plus retirees take five or more medications daily. Add to that number a variety of over the counter drugs, vitamins, and supplements and you have quite the cocktail.
Researchers report that over 20% of adverse drug reactions are due to underlying drug interactions. Drug combos can also interact to increase risk beyond “the sum of its parts,” either by canceling an intended drug action, enhancing an existing risk, or creating new risks.
The National Institutes of Health predicts there will be six million seniors with SUDs by 2020. The need for senior rehab centers specializing in tailored interventions has never been more urgent. Yet even though older adults have better results than their younger cohorts in rehab, (who said old dogs can’t learn new tricks), only 18% of treatment centers nationwide are specifically designed for them.
The warning signs are everywhere, the alarms are being sounded, yet it all seems to be falling on deaf ears. We need to begin addressing this growing, silent epidemic and we need to start right now. If we continue to ignore, deny or simply refuse to act, then we do so at our peril.
In the next edition of FULL SPEED AHEAD — and our final column on SUDs — we will focus on how families can best address this growing crisis and what they should expect and request from any treatment facilities that is designed specifically for seniors.
Allan Goldstein is a retirement coach and Long Beach resident.