Prescription Drug Abuse in the Elderly



What is prescription drug abuse?

Prescription drug abuse is when a person doesn’t take his or her prescription medicine properly. Prescription drug abuse is a term usually reserved for improper use of medicines that are categorized as “controlled substances” by the Drug Enforcement Administration. Examples include many pain, anxiety, and sleep medicine. People who abuse prescription drugs may take more medicine than their doctors instructed, take medicine when it is not needed, or mix the medicine with alcohol or other drugs. This can lead to serious problems, such as addiction, drug interactions, or even overdose.

Not all prescription drugs cause addiction. Most prescription drugs are safe and effective when you follow your doctor’s directions for how to take the medicine.


Why are older adults at risk for prescription drug abuse?

Older adults are at risk for prescription drug abuse because they take more prescription medicines than other age groups. Americans 65 years of age or older make up only 13% of the U.S. population, yet they consume approximately 33% of all prescription drugs.

Older adults are also at risk for prescription drug abuse because they often take more than 1 prescription medicine each day. This increases the risk for mistakes when taking the medicines and for drug interactions.

In addition, growing older slows down your liver’s ability to filter medicines out of your body. This means that an older adult might become addicted to or have side effects from a prescription drug at a lower dose than a younger adult.


What medicines increase the risk for abuse?

A person can abuse any type of prescription drug, but elderly adults commonly take 2 types of medicines that have a high potential for addiction:

  • Opioids are prescription drugs used to control pain. They include medicines such as oxycodone (OxyContin), oxycodone combined with acetaminophen (Percocet), and hydrocodone combined with acetaminophen (Vicodin). A person can become addicted to opioids if he or she takes an opioid for a long period of time or if he or she takes too much of the opioid.

  • Benzodiazepines are prescription drugs used to treat anxiety, panic attacks, or insomnia. They include medicines such as diazepam (Valium), alprazolam (Xanax), clonazepam (Klonopin), and lorazepam (Ativan). A person can become addicted to and feel like he or she needs more of these drugs if the medicine is taken for a long period of time.

Other prescription drugs used to control pain or treat sleeping problems may also cause addiction.


How do I tell if an older adult might be abusing prescription drugs?

If you care for or spend time with an older adult, pay attention to his or her medicines and behavior. A person who is addicted to a prescription drug may:

  • Get a prescription for the same medicine from 2 different doctors
  • Fill a prescription for the same medicine at 2 different pharmacies
  • Take more of a prescription medicine than they used to or take more than is instructed on the label
  • Take the medicine at different times or more often than is instructed on the label
  • Have behavior changes, such as becoming more withdrawn or angry
  • Often think or talk about a medicine
  • Be afraid to go without taking a medicine
  • Be uncomfortable or defensive when you ask about the medicine
  • Make excuses for why they need a medicine
  • Store “extra” pills in their purse or in their pocket
  • Sneak or hide medicine
  • Have been treated for alcohol, drug, or prescription drug abuse in the past


What should I do if I think an older adult is abusing prescription drugs?

If you suspect that an older adult is abusing a prescription drug, talk to the doctor who prescribed the medicine. Tell him or her about your concerns. The doctor will determine whether your loved one actually is abusing medicine or addicted and will help your loved one get treatment.


How is prescription drug abuse treated?

The treatment for prescription drug abuse depends on what drug is being abused, severity of the addiction, and risk of withdrawal symptoms. Treatment may include counseling, medicine, or both.

Your loved one’s doctor will help him or her find the right treatment. 


Alcohol Use and Abuse Among Elderly Parents


Anyone at any age can have a drinking problem. Great Uncle George may have always liked his liquor, so his family may not see that his drinking behavior is getting worse as he gets older. Grandma Betty was a teetotaler all her life—she started having a drink each night to help her get to sleep after her husband died. Now no one realizes that she needs a couple of drinks to get through each day.

These are common stories. The fact is that families, friends, and health care professionals often overlook their concerns about older people's drinking. Sometimes trouble with alcohol in older people is mistaken for other conditions that happen with age, but alcohol use deserves special attention. Because the aging process affects how the body handles alcohol, the same amount of alcohol can have a greater effect as a person grows older. Over time, someone whose drinking habits haven't changed may find she or he has a problem.

Some research has shown that as people age they become more sensitive to alcohol's effects. In other words, the same amount of alcohol can have a greater effect on an older person than on someone who is younger.

Some medical conditions, such as high blood pressure, ulcers, and diabetes, can worsen with alcohol use.

Many medicines—prescription, over-the-counter, or herbal remedies—can be dangerous or even deadly when mixed with alcohol. This is a special worry for older people because the average person over age 65 takes at least two medicines a day. If your parent takes any medicines, ask your doctor or pharmacist if they can safely drink alcohol. Here are some examples: Aspirin can cause bleeding in the stomach and intestines; the risk of bleeding is higher if you take aspirin while drinking alcohol. Cold and allergy medicines (antihistamines) often make people sleepy; when combined with alcohol this drowsiness can be worse. Alcohol used with large doses of the pain killer acetaminophen can raise the risk of liver damage. Some medicines, such as cough syrups and laxatives, have a high alcohol content.

Even drinking a small amount of alcohol can impair judgment, coordination, and reaction time. It can increase the risk of work and household accidents, including falls and hip fractures. It also adds to the risk of car crashes.

Heavy drinking over time also can cause certain cancers, liver cirrhosis, immune system disorders, and brain damage. Alcohol can make some medical concerns hard for doctors to find and treat. For example, alcohol causes changes in the heart and blood vessels. These changes can dull pain that might be a warning sign of a heart attack. Drinking also can make older people forgetful and confused. These symptoms could be mistaken for signs of Alzheimer's disease. For people with diabetes, drinking affects blood sugar levels.

People who abuse alcohol also may be putting themselves at risk for serious conflicts with family, friends, and coworkers. The more heavily they drink, the greater the chance for trouble at home, at work, with friends, and even with strangers.

There are two patterns of drinking: early and late onset. Some people have been heavy drinkers for many years. But, as with great Uncle George, over time the same amount of liquor packs a more powerful punch. Other people, like Grandma Betty, develop a drinking problem later in life. Sometimes this is due to major life changes like shifts in employment, failing health, or the death of friends or loved ones. Often these life changes can bring loneliness, boredom, anxiety, and depression. In fact, depression in older adults often goes along with alcohol misuse. At first, a drink seems to bring relief from stressful situations. Later on, drinking can start to cause trouble. 

Not everyone who drinks regularly has a drinking problem, and not all problem drinkers drink every day. You might want to get help if your loved one:
  • Drinks to calm nerves, forget their worries, or reduce depression. 
  • Gulps down drinks. 
  • Frequently has more than one drink a day. (A standard drink is one 12-ounce bottle or can of beer or a wine cooler, one 5-ounce glass of wine, or 1.5 ounces of 80-proof distilled spirits.) 
  • Lies about or try to hide drinking habits. 
  • Hurts himself, or someone else, while drinking. 
  • Needs more alcohol to get high. 
  • Feels irritable, resentful, or unreasonable when not drinking. 
  • Has medical, social, or financial worries caused by drinking.

Studies show that older problem drinkers are as able to benefit from treatment as are younger alcohol abusers. To get help, have your senior relative talk to their doctor. He or she can give them advice about health, drinking, and treatment options. Their local health department or social services agencies can also help.

There are many types of treatments available. Some, such as 12-step help programs, have been around a long time. Others include getting alcohol out of the body (detoxification); taking prescription medicines to help prevent a return to drinking once your parent has stopped; and individual and/or group counseling. Newer programs teach people with drinking problems to learn which situations or feelings trigger the urge to drink as well as ways to cope without alcohol. Because the support of family members is important, many programs also counsel married couples and family members as part of the treatment process. Programs may also link individuals with important community resources. Scientists continue to study alcohol's effects on people and to look for new ways to treat alcoholism. This research will increase the chance for recovery and improve the lives of problem drinkers.

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Retirement Leaves Some Vulnerable To Substance Abuse


Here's a number that may shock you: There are 2.5 million American seniors with alcohol and drug problems, and anywhere from 6% to 10% of elderly hospital admissions are the result of alcohol or drug problems.

"Drug misuse and abuse in the elderly is of special concern because it can cause cognitive and physical impairment - putting this population at greater risk for falls, motor vehicle accidents and making them generally less able to care for their daily needs," according to a report by the Center for Applied Research Solutions in Santa Rosa, Calif. "Elderly individuals are particularly vulnerable to prescription drug misuse."

Jamie Huysman, a physician and clinical adviser to Caron Treatment Centers, a drug and alcohol treatment center that recently announced a new center specifically for seniors, says retirement in itself doesn't cause unhealthy habits, but the sense of isolation and depression that some retirees feel can contribute to substance abuse.

"Sometimes the way we leave our job, whether we quit, are phased out or laid off, there is anger and pain. These things lead to events that trigger us. Those things can accelerate alcohol use."

Meanwhile, drug and alcohol abuse are separate issues, he says. Seniors are three times more likely to take prescription medications. "Drugs have become prevalent," he says. "Doctors see 30 to 40 patients a day. Pain is legitimate, and pain management is legit. It takes five minutes to say yes, and 45 minutes to say no.

"Sometimes they do have legitimate pain," he says. "Inadvertently, they become addicts or alcoholics."

Janet Taylor, a New York psychiatrist and AARP consultant, says most people think of drug abuse as illegal substances, but prescription medication is a big issue.

"The proportion of seniors on prescription drugs has tripled," she says. "The risk is enhanced. When people get prescriptions from doctors, they can be abused or misused. You feel like it's OK because you get it from a doctor."

"There are reasons why seniors may be more likely to have higher rates for drug abuse," she says. "Many are going through transitions in their lives. They may be bored. They may have physical problems that make them less mobile. Sometimes they have more free time. They may start drinking earlier in the day. But as you get older your metabolism changes. Those are some of the contributing factors to a pattern of abuse and misuse."

Huysman says that up to 50% of seniors in assisted living and skilled nursing facilities have a substance- or alcohol-abuse problem.

"Can you imagine someone who has been in the workforce for many decades and finds him or herself now among the non-working and who essentially feels adrift?" says Lynnette Khalfani-Cox, an author and personal finance expert who runs the site AskTheMoneyCoach.com.

"If someone hasn't planned and doesn't have a strong sense of what they are going to do outside of whatever role they have played in the last decade, it is disorienting," she says. "It is not just a matter of being financially prepared. It's a life purpose question. A lot of our identities are wrapped up in our titles and careers."

A look at the problem of senior drug and alcohol abuse, according to Caron Treatment Centers:
  • Health problems related to substance abuse cost Medicare more than $233 million annually. 
  • Nearly 50% of nursing home residents have alcohol-related problems. 
  • Older adults are hospitalized as often for alcoholic-related problems as for heart attacks.

Huysman says elderly patients can get addicted "right under our nose."

"When they are isolated, which seniors get, nobody sees this decline in observable behavior," he says. "They are the fastest-growing group of addicts and alcoholics in our nation."

He says sometimes in retirement there is a feeling of depression, purposelessness or a big financial strain. Sometimes there is marital strain. "They all contribute to abuse," he says.

"I went through a downsizing," Khalfani-Cox says. "It was jarring and shocking and unnerving in my 30s. Imagine a person who is 60 and goes through a downsizing and unexpectedly has to leave the workforce because of illness or having to be a caretaker. We know it is common for 40% to 50% of people to retire before they intended to," Khalfani-Cox says.

Bob Stammers, director of investor education at the CFA institute, tells clients that they can have problems if they don't know clearly what their goals are in retirement. "A lot of people don't know what retirement looks like," he says.

"A lot of people think they will sit at home," Stammers says. "Then they get home and want to travel. And they don't have the finances to do it, because they didn't plan. You have to know what your goals are so you can plan."

And they must prepare personally, as well as financially, he says. "A lot of people don't realize how much they identify with work. Sometimes retirement isn't pleasant because they aren't active and aren't engaged."


Family Conflicts Over Elderly Parents


As elderly parents begin to rely on family for more support, the amount of conflict between adult children can increase. Dealing with a parent’s care can rekindle sibling rivalries that have lain dormant for years, and the discord can tear families apart.

Learn more about family disagreements that can occur when siblings are caring for their parents.

Causes of Conflict Between Siblings Caring for Elderly Parents

Family dynamics are infinitely complex, but two underlying themes run through most sibling disputes about their parent’s care: injustice and inheritance.

1. Injustice

When one sibling shoulders a disproportionate burden of Mom or Dad’s care, that sense of unfairness can foster resentment. Often, by virtue of distance, the siblings who live further away are “off the hook” when it comes to caring for an aging parent, while the nearest siblings are obliged to take on a caregiving role. When the caregiving sibling asks for help from other siblings, the other siblings often don’t fully appreciate, or choose to ignore, how much help their parent needs, and how much work one sibling is doing.

2. Inheritance

Many siblings clash over a parent’s finances. With the average American household’s net worth declining since 2007, siblings must divide an even smaller inheritance, naturally increasing the likelihood of conflict. In a perfect world, each of us is selfless and not motivated by money, but we live in a far from perfect world where money is indispensable, so it remains a problem within families.

Caregiving is stressful on its own, but when injustice and inheritance are added to a situation, they can create animosity between siblings. When family dynamics are already tense because one sibling feels unjustly overburdened with a parent’s care, money can compound the conflict.

A sibling who provides most of a parent’s care may feel entitled to a greater share of an inheritance. Or, siblings who are more distant or not involved may believe that the caregiving sibling is spending too much money on a parent’s care. Sometimes, the children of aging parents will even resist plans for professional care in order to “protect” an inheritance.


Tips for Improving Communication with Your Siblings During a Family Disagreement

There are no easy answers to settle disputes between siblings who are butting heads over a parent’s care, but maintaining communication is crucial. Consider using these tips for improving communication with your siblings during a family disagreement:

A Family Meeting

Ideally, siblings can identify and correct issues before they become irreconcilable. The key is good communication, and a tried and true strategy to facilitate the exchange of ideas is the family meeting. At a family meeting, there should be frank and open discussion about a parent’s care needs. Each sibling’s role and obligations should be established, and future plans should be made. But if the question of where to hold a family meeting leads to a bitter argument in and of itself, the friction may have gotten past the point when a family meeting can help.

Advisors, Counsels and Mediators

Sometimes a neutral third-party can calm feuding siblings. Elder at Home, who work directly with families as they plan a parent’s care, have defused many disputes between siblings over lengthy conference calls. Family counselors can also help to bridge the differences between siblings, assuming they still talk to one another. If things have become really heated, a family mediator specializing in senior care issues may be able to break through the ill will and help build consensus and find middle-ground.

The High Road

Ultimately, the only person we can change is ourselves. No matter how much we try to reason with a disagreeable sibling, we may not succeed.

While advocating for what’s best for our parent, it’s wise to let go of anger or resentment towards a sibling who has been unhelpful or hurtful, and to strive for the undeniable peace that comes from acceptance and forgiveness; neither stifling our impulse to call out an uncooperative brother or sister, nor allowing ourselves to be consumed with anger.


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If you and your sibling(s) are disagreeing about how to care best for an elderly parent and need a informed, neutral third party who can provide advice regarding care options, don't hesitate to contact Elder At Home at 401-475-7705