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January 29, 2019

Addiction Treatment for the Elderly

We call them by several names: seniors, oldsters, old-timers, old people, elders, the elderly, aging or older adults and so on. The fact is that there comes a certain point in life that you transition from one classification of adult to an older one. It’s also a fact that addiction is a real problem among the elderly, especially addiction to prescription medications and alcohol. Getting addiction treatment that is safe and effective should be a priority for loved ones and family members of the elderly addict. In many cases, however, the question is “what addiction treatment is best?”

SPECIAL NEEDS AMONG ELDERLY ADULTS

 The elderly population in the U.S. is growing dramatically. According to key facts in a report from the Joint Center for Housing Studies of Harvard University, the most significant growth in older households came from baby boomers aged 65-74. The group expanded to over 17 million households (an increase of 26 percent) from 2011-2016. The number in the 80+ age group is expected to more than double by 2037.

Someone in their late 80s to early 90s is likely to be much frailer than their younger counterparts (those in their mid-to-late 70s or younger). The poor health they may experience means they not only may require special assistance getting around, they may have difficulty with hearing and vision, even speaking that creates challenges in providing treatment.

Insomnia

Sleep problems are a common complaint among seniors. Seeking prescriptions for insomnia often leads to taking benzodiazepines to remedy sleeplessness. Unfortunately, as a 2018 study in JAMA Internal Medicine reported, one in four older adults go on to long-term use of benzodiazepines, which may progress to dependence and addiction. Furthermore, long-term diazepine use in older adults may contribute to respiratory problems, including depressed breathing, according to a 2014 study published in Expert Review of Respiratory Medicine.

Chronic Pain

Research published in Expert Review of Respiratory Medicine looked at the increasing use of opiates in the elderly diagnosed with chronic obstructive pulmonary disease (COPD). Researchers found that opiate medications were prescribed to treat chronic musculoskeletal pain, which occurs in more than 70 percent of those with COPD. Also, due to their sedative properties, opiates are often prescribed to treat insomnia, which occurs in more than 50 percent of those with COPD.

Alzheimer’s, Parkinson’s Disease or Dementia

Benzodiazepines, commonly prescribed to treat anxiety, agitation and insomnia have been associated with a 40 percent increase in mortality among those diagnosed with Alzheimer’s disease and dementia, according to research published in the International Journal of Geriatric Psychiatry.

Substance Use Disorder

Alcohol use is another common factor complicating addiction treatment for the elderly. Seeking to combat loneliness, deal with isolation, grief, family rifts, uncertain finances and other problems often leads to alcohol consumption to numb the pain and pass the time. However, combining alcohol with prescription medications creates a myriad of problems for the senior, including development of a substance use disorder (SUD) specific for alcohol (alcohol use disorder or AUD). Polydrug use, warns the Substance Abuse and Mental Health Services Administration (SAMHSA), also exacerbates common medical conditions experienced by older adults, including stroke, osteoporosis, high blood pressure, diabetes, memory loss and mood disorders.

Inappropriate benzodiazepine use is a growing worldwide problem, according to a study published in Current Psychiatry Reports, yet only one-third of the benzodiazepines prescribed to the elderly are “considered appropriate.” The increased sensitivity of the elderly to benzodiazepine’s side effects is a cause for concern. Researchers found the most frequent inadequate situations involved the elderly taking benzos for an excessive duration or dosage, as well as self-medicating.

Abuse, dependence and addiction to prescription opiates among older seniors is another area where the statistics are alarming. While not as prevalent as among younger and middle-aged adults, opiate addiction in the elderly is more likely to have fatal consequences due to overdose and suicidal ideation and attempts. This is according to findings in 2018 research published in Drug and Alcohol Dependence.

Dual-Diagnosis

Many elderly individuals live alone, having lost a spouse or partner, possibly having no other family members or relatives nearby. They may spend their days without any human interaction, eating meager meals, sleeping fitfully, staying indoors, neglecting their self-care, either forgetting or taking prescribed medications improperly. When seniors are mired in prolonged grief, loneliness, depression, suicidal thoughts and other emotional difficulties, the situation can result in a mental health disorder that requires treatment— yet may go unnoticed for some time. Addiction treatment for the elderly diagnosed with one or more SUDs, plus a mental health disorder that co-occurs, involves treating the senior for dual diagnosis. This means simultaneous and comprehensive evidence-based addiction treatment for both conditions.

MULTIPLE MEDICATIONS FOR MEDICAL CONDITIONS

Drug interactions and side effects go hand-in-hand with elderly adults taking multiple medications for various medical conditions. Older adults may visit several doctors, specialists, general practitioners, dentists and other medical professionals without disclosing a list of all the medications they’re currently prescribed and taking. Just because they’ve been taking a medication for years as prescribed to treat a particular condition, the elderly may believe it’s safe to continue to do so, despite potential drug interactions, side effects and adverse effects.

Addiction treatment for seniors has to include compiling at intake a complete list of all prescription medications, dosage strength, frequency, how long taken and reasons for taking. Due to the fact that many elderly individuals experience forgetfulness or may have cognition problems (with or without Alzheimer’s disease or dementia), a loved one or family member most familiar with what prescription drugs the older senior has been taking should accompany him or her to the drug and alcohol rehab facility for intake, and bring as comprehensive a list of medications as possible— including prescribing doctor. Research in PAIN found that nearly half of adults 65 years and older used physician sources for their past-month prescription opiate misuse.

ELDERLY NEED A SUPPORTIVE TREATMENT ENVIRONMENT WITH PEERS

Detoxing from substances such as alcohol and prescription or illicit drugs affects seniors differently than younger adults. Withdrawal symptoms are likely to be more intense, painful or uncomfortable when someone is in their later senior years. This requires detox and medical monitoring in a drug and alcohol rehab facility that’s geared toward treating seniors and tending to their special needs.

In addition, while going through detox and subsequently entering formal treatment, the elderly do much better when they’re participating in group therapy, 12-step group meetings and other treatment, recreational and leisure activities with their peers. Beginning the recovery journey in the company of others who are of or near the same age is very therapeutic, provides a sense of community and helps erase the stigma that can be associated with addiction in the elderly.

Case management services are another important aspect of addiction treatment for the elderly, as older seniors may need help with social support after they complete treatment. This may involve linking the elderly to continuing medical, psychiatric and social resources, as well as any continuing financial assistance, meals on wheels, visiting nurses, transportation and more.

EFFECTIVE ADDICTION TREATMENT THERAPIES FOR THE ELDERLY

Since chronic pain affects nearly one in two adults and has the potential to lead individuals suffering with it to chronic opiate use—prescription opiates play a role in nearly one-third of drug overdose deaths—researchers now advocate early physical therapy treatment of musculoskeletal pain. That’s according to findings reported in Anesthesiology. Physical therapy, researchers say, can serve as an alternative treatment to opiates, and may play a role in reducing long-term opiate use. Having an effective and evidence-based alternative treatment for chronic pain is another plus in addiction treatment for seniors.

Age-Specific Treatment

Age-specific treatment drug addiction treatments for older adults helps ensure that they can assimilate and learn effective coping measures and strategies at a pace they can accommodate, especially if they have cognitive difficulties, physical conditions limiting movement, dual diagnoses and more. Coping skills to handle loneliness, loss, grief and depression are essential to effective long-term treatment outcomes.

Since many seniors in need of addiction treatment suffer from nutritional difficulties, which are exacerbated by substance abuse, careful attention to their dietary requirements by licensed nutritionists and dieticians can help speed the recovery process.

Family Therapy

Family therapy is an especially effective component of addiction treatment for the elderly. Since loved ones and family members—if there are any—are the closest individuals to the older adult in recovery, educating them on the disease of addiction and how they can best help their loved one on their healing journey augments the treatment already received and provides more hopeful treatment outcomes.

Help After Treatment

Aftercare, continuing care and alumni programs are other highly effective ways to help ensure continuing sobriety and a continuity of care for the elderly in recovery from addiction. Older adults who live alone are particularly vulnerable to relapse, and having access to ongoing medical, psychiatric and social support services in such programs can help them lead a fuller and richer life in sobriety. It also helps provide a cushion in the case of setback, since ongoing contact with such professionals means symptoms of impending relapse can be readily identified and addressed.

Learn more about drug and alcohol aftercare and rehab services.

Learn more about rehab alumni services.

For more about addiction, detox, withdrawal and rehab, check out these articles:

        1. Are There Specific Drug Addiction Treatments for Older Adults?
        2. How Long Do Withdrawal Symptoms Last?
        3. Dangers of Drug Detox at Home and Quitting Cold Turkey
        4. How to Know if You Need Rehab Treatment
        5. Prescription Opiate Detox: What to Expect from Withdrawal and Recovery
        6. Choosing Between Inpatient and Outpatient Rehab
        7. The Benefits of Inpatient Rehab
        8. What to Consider Before Trying to Detox at Home
        9. Are All Drug Detox Programs the Same?
        10. What Does a Day in Rehab Look Like?

Sources:

Anesthesiology. “Association of Early Physical Therapy With Long-term Opioid Use Among Opioid-Naïve Patients With Musculoskeletal Pain.” Retrieved from https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2718095

Canadian Journal on Aging. “Impact of benzodiazepine dependence on the use of health services: study of the health of seniors.” Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/23388325

Current Psychiatry Reports. “Benzodiazepine Misuse in the Elderly: Risk Factors, Consequences, and Management.” Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/23388325

Drug and Alcohol Dependence. “Trends in abuse and misuse of prescription opioids among older adults.” Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/25678441

Expert Review of Respiratory Medicine. “Do Benzodiazepines Contribute to Respiratory Problems?” Retrieved from https://www.tandfonline.com/doi/full/10.1586/17476348.2014.957186

Expert Review of Respiratory Medicine. “The need to address increasing opioid use in elderly COPD patients.” Retrieved from https://www.tandfonline.com/doi/full/10.1586/17476348.2016.1143776?src=recsys

Harvard University. Joint Center for Housing Studies. “Over Half of US Households Now Headed By Someone 50+, But the Nation is Ill-Prepared to House its Aging Population.” Retrieved from http://www.jchs.harvard.edu/press-releases/over-half-us-households-now-headed-someone-50-nation-ill-prepared-house-its-aging

International Journal of Geriatric Psychiatry. “Risk of death associated with new benzodiazepine use among persons with Alzheimer disease: A matched cohort study.” Retrieved from https://onlinelibrary.wiley.com/doi/abs/10.1002/gps.4821

JAMA Internal Medicine. “Factors Associated With Long-term Benzodiazepine Use Among Older Adults.” Retrieved from https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2701626

PAIN. “Sources of opioid medication for misuse in older adults: results from a nationally representative study.” Retrieved from https://journals.lww.com/pain/Abstract/2018/08000/Sources_of_opioid_medication_for_misuse_in_older.13.aspx

Substance Abuse and Mental Health Services Administration. “The CBHSQ Report.” “A Day in the Life of Older Adults: Substance Use Facts.” Retrieved from https://www.samhsa.gov/data/sites/default/files/report_2792/ShortReport-2792.html

 

 

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