Substance abuse problems amongst the elderly often go unrecognized, and with the aging of the Baby Boomer generation, the elderly population is increasing. This will result in new challenges for those treating substance abuse.

In our present society, the two main substances being abused by older citizens are alcohol and prescription medications. But heroin and cocaine dependency are increasing as well. It is estimated that by 2020, close to six million older adults will need to be treated for substance abuse.

Substance abuse among senior citizens can be divided into two groups. The first group consists of those who have abused substances all their lives. The second group consists of those people who begin their addictions later on in life. There are several reasons why people develop addiction later. Usually, these are physical or emotional triggers. Death of a loved one is a common trigger. A significant major illness resulting in surgery can be another trigger. Financial difficulties and divorce are also common triggers. As in younger people, meeting someone else with an addiction problem may exert a bad influence.

Diagnosis

Diagnosis and treatment will also be different in those over 65 (though the good news is that some individuals with substance-abuse issues actually do reach senior citizen status).

Substance abuse in the elderly is frequently misdiagnosed, as it can mimic other diseases that one might expect in the elderly due to other causes. Confusion, slurred speech, memory loss and staggering gait may be mistaken for other neurological diseases, including Alzheimer’s dementia. Screening for substance abuse is not often done in a doctor’s regular office visit for several reasons, including time limitations, lack of training, and uncomfortable feelings on the part of both doctor and patient about discussing such topics.

Impacts

Addiction at any age is devastating, and the problem among seniors is increasing. The statistics for the elderly are startling, as you can see from the sidebar on the right. Alcohol and narcotic dependency wreak havoc on a person’s health. Those individuals who struggle with these illnesses look years older than their chronological years. As we age, our bodies undergo physiological changes. The elderly can no longer process alcohol and opiates as younger individuals can. Cirrhosis, cardiomyopathy and chronic renal failure may result from substance abuse.

Substance abuse in the elderly can also cause serious social problems. Here are some of the situations I’ve observed over the years in my experience treating

addiction in the elderly:

I have witnessed a 70-year-old woman seeking treatment because she had nowhere to go. She was homeless.

I have seen a 60-year-old man going in and out of treatment programs until he finally died in a hotel room from alcohol poisoning.

I’ve observed countless relatives give up on their mothers, fathers and spouses due to addiction.

The stories go on and on.

Treatment

Once the first step of identifying those who are at risk has been taken, there are treatment options available.

If substance abuse is suspected, the senior citizen can be encouraged to go to a treatment center specializing in addiction. Group meetings may be helpful. One-to-one counseling is another option. Depending on the substance being abused, medication can be available. If the addiction is to alcohol, inpatient treatment may be necessary to detoxify the individual. Medication is available to treat opiate dependency.

Substance abuse in the elderly population is a real problem and will become a larger problem as our population ages. Newer modalities such as telemedicine may be utilized to reach isolated senior citizens who may not be able to travel to treatment centers, particularly in our rural areas. Greater awareness of this often hidden problem will be the key to diagnosis and treatment.

[Paul D. Salzberg, MD, is medical director of the crisis unit at Catholic Charities in Monticello, NY.]

Statistics on senior substance abuse
According to the National Council on Alcoholism and Drug Dependency (NCADD): 
    • There are 2.5 million older adults with an alcohol or drug problem.
    • 6% to 11% of elderly hospital admissions are a result of alcohol or drug problems. 
    • Older adults are hospitalized as often for alcohol-related problems as for heart attacks.
    • Widowers over the age of 75 have the highest rate of alcoholism in the U.S.

Indicators of possible substance abuse include:

• Falls 
• Bruising
• Cuts and burns 
• Poor nutrition
• Blackouts or seizures
• Running out of medication early 
• Recent isolation 
• Labile (easily altered and extreme) moods 
• Failing to bathe or keep clean.