Finding Treatment for Elderly Patients

Elderly individuals (people over the age of 65) are vulnerable to substance abuse like any other group of people.

If you are older and need help for a substance use disorder, you will respond to treatment the same as anyone else, but there may be some special modifications you require.

Reasons Elderly People Abuse Drugs or Alcohol

Research studies have suggested that people who are 65 or older have lower rates of substance use disorders than younger age groups. However, particular challenges which occur with age that may predispose some people to drink or use drugs.

According to the book The American Psychiatric Publishing Textbook of Geriatric Psychiatry, older people face specific life challenges that can lead to them engaging in alcohol or drug use. These include:

• Declines in physical health, strength, and mobility
• Loneliness or feelings of isolation due to the loss of a life partner, friends, or relatives
• Boredom
• A loss of a sense of purpose
• Lack of strategies or coping skills to deal with life changes
• The onset of psychological problems like depression
• A previous history of substance use or abuse

Most Salient Risks

Of the above-listed factors, the two most salient are a history of a prior substance abuse problem (or some other mental health diagnosis) and significant feelings of loss due to losing a partner, close friends, or family members.

It is rare that a person will suddenly develop some form of mental illness like depression, an anxiety disorder, bipolar disorder, an eating disorder, or some disorder for the first time after they are 65 years old, but there are certain age-related disorders that can increase the risk for substance abuse, such as problems with memory, reasoning, and other cognitive issues.

Indicators of Substance Abuse in an Older Person

The diagnostic criteria used to identify official substance use disorders that have been developed by the American Psychiatric Association (APA) are valid over all age groups. Thus, the formal diagnosis of a substance use disorder in someone over the age of 65 would require that they meet the same criteria that someone younger would have to meet.

If you suspect that an older person may be abusing alcohol or drugs, there are some other indicators that can serve as red flags.

• Secretive or solitary use of alcohol
• Adhering to a schedule of drinking alcohol before, during, and after meals
• Displaying decreased attention to grooming, hygiene, or self-care, such as not bathing as often, frequently looking unkempt, not washing clothes, or not doing chores around the house 
• Becoming more isolated from others
• Mood swings that can range from irritability to depression
• Decreased interest in social activities or hobbies that were once important 
• Health complaints 
• Frequent falls, slurred speech, or cognitive problems, such as memory loss

Substances Abused by the Elderly  

Based on reports from the National Institute on Drug Abuse (NIDA), APA, and the yearly data provided by the Substance Abuse and Mental Health Services Administration (SAMHSA), the most common substances of abuse in people who are over the age of 65 are:

• Alcohol, with alcohol use disorders being the most common substance use disorder in individuals over the age of 65
• Tobacco products
• Benzodiazepines, which are frequently prescribed for older adults to help with sleep, control anxiety, and manage seizures
• Prescription pain medications, such as opioids to address chronic pain

Different Effects

People over the age of 65 do not respond to prescription drugs and alcohol the same way they did when they were younger. Their metabolisms are typically slower, and they have less tolerance for the substances. When they combine different types of medications, such as benzodiazepines and alcohol, there is a significant risk for overdose or other problems, such as severe lethargy or sedation that can lead to accidents.

One of the highest rates of alcohol use disorders occurs in elderly individuals — those over  the age of 75 who have lost a life partner.

High rates of substance use disorders may be prevalent among nursing home residents. It is believed that a significant portion of hospital admissions of elderly individuals may be related to drug or alcohol abuse.

Abuse May Be Overlooked in Elderly People

Substance abuse issues are often overlooked and underreported in elderly individuals. Some of the symptoms listed above may be attributed to other factors like cognitive decline, physical deterioration, or the result of using multiple medications to address numerous physical issues.

Sometimes, elderly people forget if or when they took their medications and may wind up taking too many of them. This can be problematic if they are using alcohol and/or if they are prescribed benzodiazepines or some other prescription central nervous system depressant.

Elderly individuals often believe that prescription medications are not harmful because a doctor prescribed them. They may need to be instructed on the potential dangers of some of the medications they use.

Treatment for Older People

NIDA and APA consider the standard treatment protocols for substance use disorders just as appropriate for older individuals as they are for other individuals. If you know someone who is age 65 or older and needs treatment for substance abuse, there are some considerations to keep in mind.

• Any treatment protocol to address substance abuse should be appropriate for the person’s physical condition, cultural background, and age.
• No single treatment that works for everyone.
• Treatment for substance use disorders needs to be readily available, but some elderly individuals may have conditions that restrict them from benefitting from certain treatment interventions.
• For treatment to be effective, it must be delivered for an adequate amount of time. The client in treatment must understand that there is no quick fix.

The essential components of an effective treatment program for elderly clients involve:

• Respect for the client
• Treatment providers build a strong, personal and therapeutic relationship with the client
• Specialized and targeted assessment and treatment protocols
• Communicating all aspects of treatment to the client effectively
• Emphasizing social support in recovery

How to Structure Treatment for Older Individuals

Although the overall approach used to treat older individuals for substance use disorders is the same as it is for other groups, many older adults need to be educated regarding the particulars of treatment interventions.

Treating substance abuse is not like treating many other disorders that the older generations encounter. In this context, they are told to take some medication and come back later. Treatment for substance abuse requires that the person is heavily involved in treatment, changes their ways of thinking, and alters their habits.

• The treatment program should have a substantial psychoeducational component. The elderly person should be educated in understanding the effect of drugs, alcohol, and medications on their system
• Treatment providers should be specially trained to deal with geriatric issues
• Some elderly individuals might not understand the need to attend substance use disorder therapy. They may view therapy as something only for mentally ill people. They need the education to see addiction as a disease that requires treatment
• Elderly individuals in substance use disorder group therapy will most likely do better in groups that contain many members who are within their age bracket. This will allow them to better identify with others
• In reference to the above guideline, the use of peer support groups like Alcoholics Anonymous that contain many other over 65 members can be beneficial
• It is important to incorporate substance use disorder treatment into the older person’s primary care routine. Their primary care physician should be part of the process
• Older individuals might benefit from integrated treatment protocols where numerous specialists work with them on different issues.

Things to Look for in Recovery 

• Look for addiction medicine physicians and therapists who specialize in treating older and elderly individuals.
• Find peer support groups or community groups that have people of the same age bracket in the group.
• Discuss the issue of substance abuse with the person’s primary health care physician.
• If possible, get other family members or close friends involved to support the person in their recovery program.

There are addiction treatment options for people over the age of 65. All it takes is a little research and asking questions of health care providers to find the most suitable treatment plans for the elderly.

Sources

(2015) The American Psychiatric Publishing Textbook of Geriatric Psychiatry. American Psychiatric Publishing from

(2013) The Diagnostic and Statistical Manual of Mental Disorders – Fifth Edition. American Psychiatric Association from

(January 2918). Are there specific drug addiction treatments for older adults? National Institute on Drug Abuse. (Retrieved April 2019 from https://www.drugabuse.gov/publications/principles-drug-addiction-treatment-research-based-guide-third-edition/frequently-asked-questions/are-there-specific-drug-addiction-treatments

(October 2018). National Survey on Drug Use and Health: Detailed Tables. Substance Abuse and Mental Health Services Administration. Retrieved April 2019 from https://www.samhsa.gov/data/sites/default/files/cbhsq-reports/NSDUHDetailedTabs2017/NSDUHDetailedTabs2017.pdf

(June 2015). Substance abuse among the elderly: What works in treatment. California State University, San Bernardino CSUSB Scholar Works. Retrieved April 2019 from https://scholarworks.lib.csusb.edu/cgi/viewcontent.cgi?referer=https://scholar.google.com/&httpsredir=1&article=1192&context=etd