A significant percentage of seniors struggle with alcohol or prescription medication use, according to Shalu Gugnani, M.D., Medical Director of Addiction Services at Northwest Community Healthcare (NCH).
Signs and symptoms of problematic substance use in the older adult can be subtle. Symptoms suggesting an underlying substance use disorder include depression, anxiety or sleep disturbance.
“Sometimes people may look at a recently retired, aging relative and think, ‘Oh, they’re just depressed because they’re not working anymore, so they don’t have a sense of fulfillment, or they just lost their spouse.’ It is important to consider that there might be a substance use issue as well,” Dr. Gugnani says.
Sleep problems sometimes become more prevalent. Subtle signs should be communicated to a physician, alerting them to screen for a substance use disorder or other mental health condition.
Anxiety, depression, mood swings and cognitive changes like memory loss are all signs that an average on-looker might attribute to normal aging. Other times, seniors have poor hygiene or may fall frequently. It is important to understand that there may be more than just age behind these symptoms.
Of those prescribed psychoactive substances, most commonly benzodiazepine and opioids, it is estimated between 18 and 41 percent are misusing these medications in some way, according to Dr. Gugnani. Regardless of whether a patient’s misuse is intentional or not, it can be hazardous and put seniors at risk for injury or medical complications.
According to a recent National Institute of Health (NIH) supported study, benzodiazepine has been increasingly prescribed to seniors as a sedative or anti-anxiety medication, despite guidelines that caution of dangers.
“Today, there is a push to treat pain as the fifth vital sign,” says Dr. Gugnani. “We tend to go to the easiest mechanism to treat pain — opioids. This is appropriate in some settings, like in the management of acute or post-operative pain such as cancer or palliative care.”
Dr. Gugnani explains that we have to look at the long-term benefits and potential dangers of prescriptions and move forward in a slow, cautious manner.
“In terms of chronic pain, I think we need to look at what solution will do the least amount of harm and work forward in a step-wise manner,” Dr. Gugnani says. “If we do need opioids, proceed with caution in limited quantities, frequently checking in on the patient’s condition.”
Seniors and alcohol use
“Up to 16 percent of our senior population has an alcohol use disorder,” Dr. Gugnani says.
In cases involving aging adults, alcohol use can impact other medical problems significantly.
The NIAAA states that “healthy adults over age 65 who are healthy and do not take medications should not have more than three drinks a day or seven drinks in a week.”
A senior adult drinking more than this amount is at greater risk of serious alcohol problems.
There are two types of prevalent alcohol disorders:
Early onset drinkers who may have had issues with alcohol earlier in their lives; and
Seniors with increased alcohol consumption due to major life changes like retirement or loss of a spouse. (Clinicians are hesitant to screen patients who have never before presented with alcoholic issues.)
“There are oftentimes dismissing attitudes surrounding the older population,” says Dr. Gugnani. “Some may say, ‘Oh, we’re not going to change them now — they have been this way their entire adult life.’ Or, sometimes the extent of a problem is attributed to a life change or disappointment. It’s important that one presses forward to assist seniors in meeting a higher quality of life.”
When speaking to physicians, seniors should be very honest about how they’re feeling. They should discuss when they have had major life changes, like retirement or the loss of a spouse, and they should ask for help when they need it.
When prescribed new medications, patients should ask about how a new drug may affect other medical issues and understand possible side effects.
Family members are more likely to reach out on behalf of a senior loved one. If you or someone you care about has a use disorder or they’re struggling more than they should be, a better quality of life is waiting.
Dr. Gugnani worked with a patient diagnosed with alcoholic cirrhosis of the liver who couldn’t be placed on the donor list due to his alcohol use disorder. After being treated at the NCH Adult Residential Addictions Center, and with continued follow-up in the addiction medicine clinic, he is enjoying a renewed outlook on life. According to Dr. Gugnani, he is now nine months sober and a candidate on the transplant list with careful monitoring of his recovery program.