CONTENTS

Table of Contents
Introduction

1. Overview
2. Recognizing Alcohol Misuse and Abuse in Older Adults
3. Alcohol and Aging
4. Diagnosing Alcohol Problems in Older Adults
5. Recognizing Other Forms of Substance Abuse
6. Prevention and Early Intervention Strategies
7. Treatment
8. Outcomes and Cost Issues in Alcohol Treatment for Older Adults
9. Legal and Ethical Issues

Supplements
Resources

At Any Age, It Does Matter:
Substance Abuse and Older Adults (for Professionals)

Risk Factors for Medication Misuse and Abuse

Medication misuse can take many forms, including the following:

• Mixing drugs and alcohol in hazardous ways or using contraindicated drugs or food
• Taking a nonprescribed dosage
• Taking extra doses or taking medication when it is not needed
• Failing to fill a prescription
• Failing to follow instructions, such as taking a drug with food
• Skipping doses, double dosing, taking medication at the wrong time
• Stretching out medications to last longer or discontinuing earlier than directed
• Using outdated drugs, not monitoring side effects, improperly storing drugs
• Sharing or borrowing drugs
• Using drugs to hurt oneself
• Taking an entire day’s medications in the morning for fear of forgetting to take all the doses of all the medications as prescribed
• Taking the wrong drugs
• Supplementing prescribed drugs with over-the-counter medications or “leftover” medicines from an earlier illness
• Engaging in contraindicated activities while taking the medications (e.g., driving motor vehicles, spending time in the sun)
• Failing to tell the prescribing physician about all the other medications (prescribed and over-the-counter) being used or to report significant or unexpected side effects or adverse reactions

Risk of drug misuse among older persons increases for many reasons:

• Multiple physicians prescribing and multiple prescriptions often cause drug misuse. A recent study found that three out of every four older patients may be vulnerable to hazardous pharmacological mismatches. Nearly 75 percent of doctors caring for older patients taking four or more prescriptions are unaware of all the drugs their patients are taking.
  
  The study also showed that 74 percent of the patients were taking at least one prescription medication that the doctor was not aware of. In many cases, there was at least one drug the doctors thought the patient was taking that the patient was not.⁵³ Physicians also may be unaware of over-the-counter drugs and herbal supplements patients are taking.
  
  Multiple prescriptions present certain hazards. One drug might increase, reduce, or neutralize the effects of another drug. Two similar drugs taken together might have an effect that is greater than would be expected from one drug.
  
  Drugs may also produce harmful interactions. For example, concurrent use of monoamine oxidase inhibitors (e.g., Nardil, Parnate) and tricyclic antidepressants (e.g., Elavil, Wellbutrin) can cause serious reactions, such as tremors, convulsions, and hyperthermia.
• Instructions and package inserts may contain unfamiliar terms or present problems for people who have trouble with English or who have low literacy skills.
• Prescription sharing, especially in retirement housing, is sometimes problematic.
• A person may not consider over-the-counter medications, megadose vitamins, or herb preparations to be “drugs.”
• People may stop taking medicine when they feel better, causing symptoms to return.
• The relatively high cost of drugs may lead some older people to use less than prescribed amounts, which also is misuse. In surveys of psychiatric drug use by older adults, underuse was more common than overuse.
• Failing memory or cognitive impairment can result in a person not understanding instructions for taking medications or remembering whether medication was taken.
• Alcohol use may affect the ability of the older person to take medication correctly.
• Depression, frustration, and self-neglect can impair an older person’s ability to take medication correctly.
• Persons living alone are more likely to make mistakes in their drug doses.

Multiple drugs and complex medication regimens create additional risks:

• With multiple medications, dosage schedules often become more complicated.
• The risk of adverse drug reactions increases with each drug a person takes. Older adults are almost twice as likely as younger people to have adverse drug reactions.⁵⁴ In addition, persons who have had prior adverse drug reactions are at risk for future reactions.
• Significant medication errors are made when an older person has to coordinate three or more prescriptions at one time, each of which is taken at different times, some with food, some without food.

Sensory impairments increase the risk of misuse of medications:

• A person with a hearing problem may not hear instructions for taking medications correctly.
• Poor vision may make it difficult to correctly read labels. Even warning labels are often in small print.
• Physical ailments such as arthritis, weakness, and loss of coordination can also pose problems, such as difficulty opening bottles.
• Some people may have problems swallowing tablets or capsules and may need a liquid or a skin patch.

Older adults are more likely to be taking prescription medications that have a greater potential for being toxic. These include:

• Cardiac drugs (e.g., calcium channel blockers such as Cardizem, beta-adrenergic blockers such as Inderal and Lopressor)
• Diuretic drugs (e.g., Lasix)
• Antihypertensives (e.g., Hylorel, Ismelin)
• Anticoagulants (e.g., Coumadin)
• Central nervous system depressants (e.g., Valium, Demerol)

In addition, physical conditions such as decreased kidney function, low body weight, and cancer can lead to medication-related problems. These conditions can compromise the ability to safely metabolize and clear medications.