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 and Dangers Associated With Prescription Drugs

Several interrelated factors can contribute to substance abuse among older adults. These include losing a spouse, living alone, and moving from a long-loved home into an apartment. Physiological changes that accompany the aging process can also make a difference.

Older people are more likely to hide their addiction and less likely to seek professional help. Therefore, health officials urge family members to identify the problem and get help.¹

The dangers associated with prescription drugs include problems caused by age-related changes in drug metabolism, drug interactions, and alcohol-drug interactions. Unfortunately, these agents, especially those with longer half-lives, often result in unwanted side effects that influence functional capacity and cognition. These effects place older persons at greater risk for falling and institutionalization, as well as memory loss and automobile-related injuries.²

Drug information is available on hundreds of medications. This information includes alcohol warnings, possible side effects, and special considerations for older persons. In addition, it helps to be familiar with types of drugs that older adults should avoid.

Older users of psychoactive prescription drugs experience more adverse effects than younger adults, including:

• Excessive daytime sedation
• Ataxia
• Cognitive impairment

Such medication-related problems may be due to many factors:

• A wrong or unnecessary drug being prescribed
• Wrong dosages (too high or too low)
• Adverse drug reactions
• Failure to take medication properly or to receive a drug (e.g., for economic reasons)

Additional problems may include confusion, depression, delirium, insomnia, urinary retention, incontinence, weakness, lethargy, loss of appetite, falls, and changes in speech and cognition. It is important to note that some older persons do not receive medication when it is needed. Underprescribing can be a problem; heart failure, incontinence, and depression are undertreated in the older population.

Attention, memory, physiological arousal, and psychomotor abilities are often impaired. In addition, drug-related delirium or dementia may wrongly be diagnosed as Alzheimer’s disease. A recent study found that drug side effects in older adults may mimic dementia.³ Therefore, it may be wise to consider symptoms in older adults to be drug side effects until proven otherwise.