Michigan Older Adult Substance Abuse Network

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Network Profile Winter, 1999

Articles

• Older Adults: A High Risk Group for Substance Abuse
• A Common Sense Approach: Safe Use of Medication by Older Adults

Older Adults: A High Risk Group for Substance Abuse

"A High Risk Group For Substance Abuse" as a title probably congers Images of misbehaving teens or wild eyed, young adults full of themselves and ready to PARTY! Few of us are prepared to think of our elders, our parents in particular, older relatives, or friends as being "at risk." More and more as the older population grows in number—they are.

The factors leading to this conclusion are several: there are biological changes that occur as we age, and an increased likelihood of medication use. In some cases, seniors may lack accurate information in a usable form about the medication prescribed In­creased isolation, unresolved grief, and noncompli­ance issues emerging from social and financial reali­ties create risks for older adult substance abuse, as well.

Other factors framing the substance abuse risks for our elders are less obvious, hidden within demo­graphic and research data presented from a multi­tude of sources—universities, research centers, medication manufacturers. Risk issues for seniors extend beyond those associated with prescription medica­tion to over-the-counter drugs, vitamins, supple­ments, and other compounds. And let's not forget— alcohol!

Older adults are almost six times more likely than other age groups to be hospitalized for adverse medication reactions.

Risks due to high consumption of drugs:

• Older adults constitute approximately 12% of the population.
• Older adults consume over 24% of all over-the­ counter medications.
• Older adults use at least one-third of all prescription drugs.

Risks caused by the number of medications taken concurrently:

• Average older adult uses 4.5 prescription medications daily.
• Average older adult takes 2 over-the-counter medications daily.
• Those with multiple chronic conditions often take more.
• As the medication circulating in the body increases, the potential for adverse drug reactions is high

Risks created by biological intolerance:

• Most drugs have been produced for younger individuals, few specifically for older adults.
• 17.5% of the 30 million Medicare recipients are prescribed medications generally unsuitable for their age group because of lack of awareness or inadequate options.
  
  

  Adapted from "When Medicine Hurts Instead of Helps, Alliance for Aging Research"

Risks due to abuse or misuse of prescription medications

• For individuals 85 years of age and older, 35% of visits to the physician resulted in prescriptions for three or more medications (Cancer Control, 1998)
• Older adults experienced more than half of all reported drug reactions, which resulted in hospitalization, although making up less than 13% of the population. (Chastain, 1992)
• Thirty percent of individuals over 65 take eight or more prescription medications a day, which in addition to aging related changes in medication metabolism, make them at risk of adverse drug reactions and drug interactions. (Sheahan et al. 1989)
• Adults aged 50-59 are 33% more likely to experience adverse drug reactions than those 40 to 49. Over 59 years of age, the risk level increases to two or three times as great for younger populations. (Per­spectives in Health Promotion and Aging, Vol. 5, #1,1990)
• FDA data indicate a rate of 8.5 adverse drug reactions per 100,000 people in the general population, and 16.0 per 100,000 in individuals over 65. Clanner et al., 1989)
• The U S. Department of Health and Human Services reports 32,000 deaths annually from falls of older adults are drug induced. (Perspectives in Health Promotion and Aging, Vol. 5, #1, 1990)

Risks due to abuse or misuse of over-the-counter medications

• In the United States, consumers spend over $5 billion annually for over-the-counter drugs.
• The most common and prevalent form of medical care among older adults is self-medication with use of over the counter drugs. Over the counter drugs are taken at least 1.5 times every two weeks for a national total of over a billion times a year by this population. (Evashwick, 1991)
• In a nationwide study of the use of over-the-counter drugs, older adults reported experiencing 4.2 everyday health problems during a two week period. Of these problems, 35% were not treated at all; 11% were treated with home remedies; a physician or dentist was consulted for 13% of the problems, a previously prescribed medication was used 15% of the time and 35% of the time over-the-counter medications were used. (Evashwick, 1999)
• Many older adults do not consider over-the-counter drugs as medicine and do not report using them to physicians. Drug interactions can easily occur. In a survey of patients with cancer at the Moffitt Cancer Center, 47% of the older adults were taking non-prescription drugs, but did not report them as medications. (Cancer Center)
• Older adults are seven times more likely to use over-the-counter medications than the general population, and at least half of these medications are analgesics.
• Forty percent of people over age 60 use over-the-counter medications every day and 80% of these use alcohol, prescription drugs, or both (Growth At Any Age, A Comprehensive Resource Guide, 2nd Ed. © 1998)

Risks due to the use, abuse, or misuse of alcohol by older adults

• An estimated 2.5 million older adults experience alcohol related problems, and 21% of individuals over 40 have a possible diagnosis of alcohol abuse or dependence resulting in hospital costs of $60 billion per year. (Schonfeld and Dupree, 1995)
• Abuse of alcohol may accelerate the normal decline in physiological functioning associated with aging. (Gambert and Katsoyannis, 1995)
• Older adults experience consequences with less alcohol consumption due to their heightened sensitivity to alcohol or the presence of such coexisting diseases as diabetes mellitus, hy­pertension, cirrhosis, or dementia. (Atkinson and Gazini, 1994)
• Rates of alcohol related hospitalizations among older adults are similar to those for heart attacks. (Adams et. al., 1993)
• Studies consistently find that elders are less likely to receive a primary diagnosis of alcoholism than are younger adults. (Booth et al., 1992)
• Researchers speculate that the change in relative alcohol content combined with the slower reaction times frequently observed in older adults may be responsible for some of the accidents and injuries that plague this age group. (Bucholz et al., 1995; Ray, 1992)
• According to the National Council on Alcoholism, one out of every three families is directly impacted by alcoholism. (Substance Abuse Among Older Adults, Treatment Improvement Protocol (TIP) Series, Frederic C. Blow, Ph.D., 1998.)

A Common Sense Approach: Safe Use of Medication by Older Adults

As the older adult population grows, our awareness of the importance of knowing the answer to this question grows—"When is Medication Use a Risk?"

Common Sense About Medicine.

Part of the answer involves common sense. We know that some older adults have vision problems and need LARGER PRINT medication information, including medication WARNING labels. Many elders suffer from arthritis and will benefit from easier to open packages. Literacy may be an issue for some. And always a major concern for all income levels— WHAT DOES IT COST?

There are other questions that seem obvious, but when not answered create the potential for risk associated with harmful use or misuse. For example:

• What is the medicine called?
• What is this drug supposed to do?
• Is this a brand name medicine or a generic drug?
• Are the instructions for taking the prescription clearly understood?
• Are the common side effects known?
• What is the medication for?
• Can this medicine be used safely with other prescription drugs?
• Can it be used safely with over-the-counter medications?
• Will alcohol use effect the medication?
• What foods or activities need to be avoided?
• Is written information available? In various languages?

For medical, social work, and aging services professionals, these "common sense" aspects of older adult medication use create ongoing challenges. Seniors who have been healthy, using few or no medication, have to be educated and monitored. Individuals may hold values or myths passed on from generations passed regarding drug use. Noncompliance with the instructions requires constant vigilance for caregivers—both professionals and family members.

Are we currently prepared to apply common sense as we set out to solve these ever increasing risk factors? At what level is the risk of harm lessened sufficiently? Are we going to accept medical health and independence for a fortunate percentage of our crowing elder population, or will we be determined to improve conditions for all aging Americans?

The questions we raise today have been the focus of community based initiatives to provide supportive care for seniors for the past two decades, and from time to time, new initiatives create foundations for future paradigms.

Serious challenges remain: for state-wide and national organizations to provide accurate, up-to-date information; for local pharmacies and medical groups to provide affordable services; for substance abuse prevention and treatment organizations to promote healthy choices and effective alternatives and for all of us to seek common sense solutions which insure safe use of medication.

Getting older? Wondering if you'll be indepen­dent? Or will you develop one or more of the litany of aging-related health conditions - loss of vision, hearing deficits, painful joints, heart failure, difficulty breathing, arthritis? perhaps cancer? or an emotional problem, such as depression or anxiety? Is there any relief on the horizon?

The most significant health care technology, affect­ing a majority of older adults, is medication. The safe and appropriate use of prescription and over-the-counter medication can prevent or delay illness, limit disabling conditions, and prolong life. We hear of "medical miracles" in cases where the effective ap­plication of medication restores an individual to func­tional, independent living.

All well and good? Right? Maybe not...

A report issued by the Alliance for Aging Research, a nonprofit organization that promotes medical re­search on human aging, draws attention to the darker side of the medication scene. The report, When Medication Hurts Instead of Helps, highlights data from fifty principle studies, which indicates older adults in America are at high risk of being harmed by medi­cations.

The report points out that individuals age 65 and older are most vulnerable to the harmful effects of medication due to the biological changes which ac­company aging and the number of medications be­ing used. One study noted that America's elders are six times more likely to require hospital care because of damage caused by medication.

The numbers indicate that older adults, who comprise 13-14% of the total population, use one quarter of over-the-counter drugs, and up to a third of the prescribed medications. An additional concern occurs when the number of medications used by individual elders increases. The Aging Research Alliance estimate tells us that the average senior consumes 4.5 prescription medications each day, along with two over-the-counter meds. Adding to this chemical soup are supplements, vitamins, and various "home remedies," leaving many older adults in arm's way.

Age related illness (mentioned above), the slowing down of the biological processes of absorption, distribution, metabolism, and elimination, plus the potentially potent combination of prescribed and non-prescribed substances, can create a maelstrom - a medication nightmare!

Adding to the problem is the possibility that elders may react to the medications they use. Some older patients display paradoxical effects - the opposite of the intended effects. Some of the research indicated problems caused by the potency of medication, leaving the elder "at risk" for biological intolerance. The medicine, designed for younger populations, creates a medical imbalance in the elderly. Some of these iatrogenic results are caused by incomplete assessment, others occur when the alternatives to the medication are limited or absent.

The focus of the When Medicine Hurts Instead of Helps Alliance for Aging Research report is to highlight prevention strategies to reduce the risk of harmful medication use, and suggests approaches that will engage existing problems. Key approaches suggested for policy makers, older adult patient advocates, and caregivers include:

• Direct government health agencies to distribute lists of medication considered dangerous for older patients.
• Encourage pharmaceutical companies to study medication effects in older adults using pre- and post-­marketing clinical trials.
• Develop labeling that will help older adults understand the appropriate and effective use of over-the-counter medications.
• Require competency in geriatric pharmacy for health care and aging service professionals.
• Provide accurate, up to date information to family and other caregivers of older adults in order to prevent misuse of medication.
• Provide accurate, up to date information to family and other caregivers of older adults in order to prevent misuse of medication.

To obtain copies of the When Medicine Hurts Instead of Helps and for additional information on medication problems of older adults, contact: Alliance for Aging Research at (202) 293-2886, or fax a request to (202) 785-8574.