As we age, our health gradually declines. The quite normal aches and pains of youth and middle age become more painful and debilitating. Moreover, our capacity to fight off infection and disease diminishes, and when we are injured or become ill, the healing process is slower. As a result, an increasing number of older persons are using prescription medication to provide relief for the discomfort of aches and pains associated with illness and aging.
The overuse and abuse of prescription medication is the most common form of drug abuse among the elderly. Although persons 65 years of age and older comprise only 13 percent of the U.S. population, they consume approximately one-third of all medications prescribed. The National Institute on Drug Abuse reports that elderly persons use prescription medications three times as frequently as the general population and have the poorest rates of compliance with directions for taking medications. It is now estimated that 17 percent of persons aged 60 or older are affected by prescription drug abuse.
- Narcotic analgesics. Narcotic analgesics are prescribed because of their pain-relieving properties. Medications that fall within this class include morphine, demerol, codeine and their closely related synthetic cousins. Morphine, one of the most powerful pain relievers available, is used to treat severe pain on a short-term basis. Codeine, on the other hand, is prescribed for milder pain. Other examples of commonly prescribed narcotic analgesics derived from codeine include Oxycontin®, Darvocet® and Vicodin®.
- Sedative-hypnotic drugs. Sedatives are drugs that reduce feelings of stress and nervousness and induce mental calmness. The term sedative is virtually synonymous with the term anxiolytic, which is a drug that reduces anxiety. Hypnotics are drugs that are used to promote sleep. The categories are not mutually exclusive. In fact, when sedatives are given in relatively high doses, they induce sleep just as the hypnotics do. Conversely, when hypnotics are given in low doses, they can induce daytime sedation, impair cognitive functioning and coordination, which increases the risk of falls and other accidents. Commonly prescribed drugs in this class include tranquillizers such as Valium®, Xanax® and Soma® as well as sleeping preparations such as Ambien®.
Older persons are more likely to become mentally and physically impaired by psychoactive and mood-altering medications because of their decreased liver function. With increasing age, the liver loses its ability to metabolize medications. Consequently, elderly people require smaller doses of medicine to achieve the desired therapeutic effect.
When dosing is not adjusted for age and liver function, overdose, sedation, mental impairment and dependency can occur. This is particularly problematic and dangerous with pain medication, sedatives and tranquillizers.
Signs of misuse or abuse include:
- cognitive impairment, confusion, poor memory
- increased falls, accidents and injuries
- daytime drowsiness and poor and unrefreshing sleep
- secrecy or dishonesty about medication use
- frequently running out of medication before the next scheduled refill
- feigning illness or injury to attain medication
- doctor shopping, e.g. seeing more than one doctor for the same problem
Identifying prescription drug abuse among the elderly is difficult because the normal warning signs of substance abuse can be masked by concurrent illnesses and chronic conditions such as chronic pain, sleep problems, anxiety, depression or confusion. Therefore, experts recommend that persons older than age 60 be screened for alcohol and prescription drug abuse as part of the routine physical examination.
If you are concerned that an elderly parent or friend may be abusing her prescription medication, seek professional help.
CSAT. Substance Abuse Among Older Adults (TIP #26): Physicians Guide. DHHS Pub. No. (SMA) 00-3394. SAMHSA, 2000.
Summary of Findings from the National Household Survey on Drug Abuse. DHHS Pub. No. (SMA) 00-3466. SAMHSA, 2000.
By Drew Edwards, EdD, MS
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