An elderly person with slurred speech, slow motor movement and loss of cognitive ability could simply be aging or showing symptoms of common diseases such as dementia, Alzheimer’s or Parkinson’s disease. Or those symptoms could be signs of prescription medication abuse.
It’s a question that’s getting asked more often by health professionals who deal with the elderly, said Lois Ustanko, director of faith community nursing for Sanford Health: “Maybe something else is going on.”
Addiction experts say elderly prescription drug addicts are going unnoticed, in part because it’s hard to balance seniors’ legitimate medical concerns and the potential for abuse. Loss, isolation and easy access to medication make it increasingly common for aging adults to become addicted to the drugs they need to sleep through the night or manage their chronic pain.
“It seems so very unlikely for older people to be addicts, it just doesn’t come up on anybody’s radar screen,” Mike Kaspari, a registered nurse and program director of First Step Recovery in Fargo.
But the number of people 55 and older admitted to the emergency room across the U.S. because of nonmedical use of prescription drugs more than tripled between 2004 and 2011, according to the Drug Abuse Warning Network.
Problem bound to grow
Only about half a dozen elderly people seek treatment at First Step Recovery per year, Kaspari said. But that number isn’t indicative of the number of aging people in the Fargo- Moorhead area who struggle with addiction, he said.
In North Dakota, less than 90 people over age 55 sought treatment for chemical dependency in 2012, the most recent year for which data is available.
“That age group is by the far the most underreported with these substance abuse issues. I only see that getting worse,” Kaspari said.
Kaspari and other experts expect the need for drug treatment for aging adults to explode as baby boomers enter retirement in force.
Researchers, law enforcement and health officials most often see younger populations as the cause for concern about prescription drugs. More than 10 percent of adults age 18-25 reported nonmedical use of prescription painkillers, compared to just 3.4 percent of those 26 and older, according to the 2010-11 National Survey on Drug Use and Health.
But the elderly have easy access to some of the most habit-forming prescription drugs around.
A quarter of the narcotic pain killers, sleeping pills and tranquilizers dispensed in the U.S. are prescribed to adults age 60 and older.
The number of prescriptions for controlled substances dispensed in North Dakota has increased by 35 percent since 2008, according to data from the North Dakota Prescription Drug Monitoring Program.
Part of that increase can be attributed to a greater number of pharmacies reporting, but Mark Hardy with the North Dakota Board of Pharmacy said the overall trend shows increasing prescriptions.
So far in 2013, more than 118,000 prescriptions for Vicodin were dispensed in North Dakota – a total of 620,000 pills, according to monitoring program data.
Older adults are often seen as a source for younger users looking for pills.
“Some of the younger people that abuse opiates have received some of their medications from an elderly person that they knew,” said Connie Longie, a licensed addiction counselor at ShareHouse in Fargo.
She said that’s one of the biggest red flags when it comes to seniors and prescription medication.
The majority of the older adults Longie deals with are alcoholics – another area of concern since many are taking medications that shouldn’t be mixed with alcohol.
Unlike younger addicts, the elderly don’t have to “doctor shop” for prescriptions. They likely have a few doctors they see on a regular basis for a variety of different ailments.
“It’s hard to tell if it’s drug seeking behavior, or if it’s just the patient trying to medicate the chronic pain they have. Initially it’s very hard to tease those things out,” Kaspari said.
Dealing with seniors who become addicted to their medications is even murkier because many of them have medical needs that warranted a prescription in the first place.
“People legitimately need help with their pain. I don’t want to minimize that,” said Beth Brantner, who performs interventions with the Lost and Found Ministry.
Many seniors have chronic arthritis, or pain from back, hip and knee surgeries.
Brantner said the medical community doesn’t always do the best job of monitoring the drugs patients are taking and seniors place a lot of trust in their doctors.
“A common thought is ‘My doctor told me I should do that,’ so it’s OK,” Brantner said.
But prescription drugs can hurt seniors just as much as they help.
“Chemical dependency is progressive. People don’t take notice of it until a consequence happens,” said Shauna Eberhardt, a licensed addiction counselor with Drake Counseling.
With older adults that consequence is usually health-related. Overuse of medications can lead to injuries, falls or motor vehicle accidents.
“Unfortunately for a number of elderly, those types of injuries will be life-threatening,” Ustanko said, because they can easily develop complications that affect their long-term health.
Incidents like these can help cue medical professionals and families in to what’s really going on under the surface.
“They are kind of under everybody’s radar to a certain extent, until something happens with their physical health that is too hard to ignore,” Kaspari said.
Isolation heightens risk
Seniors are more likely to be open about their physical symptoms – aches and pains, difficulty sleeping – rather than mental and emotional symptoms, Ustanko said.
But many become addicted to prescription drugs or alcohol because they’re medicating the emotional pain that comes with aging.
Entering retirement triggers a series of losses starting with the loss of a job and purpose. A senior might lose friends or a spouse on top of the physiological changes that come with aging that limit a person’s ability to be independent and do many of the things he once enjoyed.
“Pretty soon the world looks pretty drab and small,” Ustanko said.
Eberhardt said it’s not uncommon for senior addicts to be dual-diagnosed with depression.
It can be hard to tell if an elderly family member is abusing medication or is depressed because they become very isolated.
Adult children or other family members might only visit a few times a year without noticing changes in their behavior.
“A lot of times if they don’t have family members around, there’s less accountability,” Eberhardt said.
It’s less likely for seniors in retirement communities or assisted-living facilities to hide an addiction because they are less isolated.
Representatives of two long-term care facilities in the area – Eventide and Bethany Homes – said they have protocols in place to prevent residents from drug abuse, as medications are closely monitored.
Addiction counselors agreed that problems were likely to start with seniors living independently.
Ustanko said her nurses, who do home visits with patients as often as once per week, are often the ones noticing these changes because family members are out of the loop.
Even when family members become aware of a problem, some are afraid to confront an elderly family member with an addiction, Eberhardt said.
“Societally, the perception is that once someone reaches a certain age, they can feel free to live their life that way,” she said.
An elderly person might also be hesitant to seek help because of the social stigma around addiction and mental health issues. Their perception is dramatically different from other generations who know it as a disease that can be treated.
“There’s sort of a code of silence … that can limit their access to help,” Kaspari said. “To have them is really perceived as a deficit, a weakness, a moral shortcoming.”
An addiction shouldn’t be “something you will go to your grave denying you have,” he said.
Author: Cali Owens, INFORUM
Date: July 27, 2013