Substance abuse in the Elderly- It’s never too late…

Volume 3 Issue 3 March, 2013

An Invisible Epidemic: As the proportion of older people in the population is increasing rapidly even in India, Substance abuse in elderly is a hidden epidemic both in India and in the west. A recent Indian study reveals that 5-8% of elderly abuses substances. Prevalence studies from Western literature quote 17-24% for drug abuse and 10-17% for drug dependence. The problem is alarming in West as the Baby- Boomer’s cohort is aging, the number of elderly who abuse drugs may increase as this cohort has high rates of drug abuse. Other than Alcohol and benzodiazepines, prescription drug use poses greater problem in elderly.

Despite the rise in numbers this is often under-diagnosed and under-treated. Common reasons include

Ageism- tendency to explain problems as a function of being old rather than looking for specific medical, social, or psychological causes.
Family’s attitude- “Granny’s cocktails make her happy”, “He won’t be around much longer anyway”
Substance abuse problems may be overshadowed by the other medical problems
Stigma, shame, or denial associated with elderly substance use
May be fewer social problems like losing a job or legal difficulties when compared with young

Physiology of ageing relevant to drug abuse: Ageing causes increased fat stores, decreased muscle mass & body water content. Long acting drugs act for longer duration than expected and short acting drugs tend to attain higher peak levels more quickly. Blood flow through the liver decreases and the metabolic capacity decreases. Alcohol use increases liver enzyme induction and increases the metabolism of some drugs. These changes cause serious physical effects even when drugs are taken at lower doses.

Elderly who are at risk for substance abuse: Separated or divorced, who are bereaving, experiencing boredom, have a family history of substance abuse, suffering from mental illness and socially isolated.

Dangers of Geriatric Substance Abuse: Increased rate of hospitalizations, drug related delirium, adverse reactions when combined with other prescriptions, early cognitive decline, high incidence of falls and fractures, highest rate of completed suicide. Elderly who use benzodiazepines are more likely to need help for activities of daily living much earlier than non-BZD users.

Substance use in elderly is both a current problem and a future concern. Physicians, general practitioners and psychiatrists dealing with elderly should be aware of this and screening for drug abuse should be part of routine work up. Treatment focusing on coping and rebuilding social support network has shown benefits and

All of us should ensure that, It’s never too late…..