Table of Contents

About This Course

1. Introduction to Elder Abuse
2. The Basics of Elder Abuse
3. Substance Use and Other Risk Factors
4. Screening and Assessment
5. Intervention and Treatment
6. Preventing Elder Abuse

Supplements
Case Studies
References
Resources

Out of the Shadows
Uncovering Substance Use and Elder Abuse

Alcohol, Drugs, and the Aging Process

Understanding how and why substance abuse occurs among older adults is an important step toward finding solutions that address these behaviors and attitudes contributing to elder abuse.

Not all substance "use" should be classified as "abuse." Clinicians differentiate among use, abuse, and dependence of alcohol and other substances. Some older adults may have abused alcohol or other substances for years. Others may have developed a problem only after the onset of health problems or conditions that eroded resiliency. Clinicians stress the importance of understanding the pattern of onset for alcohol and other substance problems. They differentiate among early onset, late onset or intermittent periods of abuse.

Aging

Aging changes the way drugs are absorbed, metabolized, distributed, and removed from the body. These natural changes can increase the potency of alcohol and other drugs. In addition, not all older people and their families are aware of the fact that alcohol by itself or in combination with other drugs can create medical, psychological, and other problems for older people or that some drugs may interact in dangerous ways.

Longevity

Older adults are living longer than any previous generation, and they are living with more chronic diseases and disabilities that can be managed with the benefit of modern medicines.

Medications

According to available data, older Americans made up about 13 percent of the population but they consume about a quarter of all prescriptions. As many as 30 percent of those over 65 years take eight or more prescription drugs daily, creating potential for misuse and abuse by older adults.

Psychological Factors

Psychological factors also can contribute to an older person's increase of alcohol or other drugs. Older people experiencing losses due to retirement, relocation, or death of a spouse or close friend, and physical impairments may turn to alcohol to ease the pain.

Cognitive Decline

Failing memory or cognitive impairment may result in an older person having difficulty understanding the instructions for taking medications or taking the medication at all.

The disturbing consequence of these conditions, behaviors, and attitudes is the fact that about one in five older adults misuses alcohol and prescription drugs. Given the odds for mistakes and abuse, the statistics may not be all that surprising. What is surprising, however, is the apparent acceptance of these deplorable statistics among the general population.

Source: U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Substance Abuse Treatment. (1998). Treatment Improvement Protocol Series No. 26: Substance abuse among older adults (DHHS Publication No. [SMA] 98-3179). Rockville, MD: Author.