Substance Abuse in Elderly Population

PowerPoint Slides Transcript
Slide 1
(Title Slide)
Substance Abuse in Elderly Population
Slide 2
Overview
When one thinks of substance abuse or drug addiction, the picture that is likely to come to mind is that of a young or middle-aged man with a rugged look who has wasted away as a consequence of substance and drug abuse. Cases of substance abuse in the older population have reportedly been on an upward trend. Indeed, as will be demonstrated elsewhere in this discussion, alcohol has emerged as one of the substances that is most abused among this particular population. This is alongside other substances including, but not limited to, prescription and illicit drugs.
In this discussion, I intend to highlight the prevalence of substance abuse among older adults. In so doing, I will discuss the various mental health disorders and how they impact this particular population. Further, I will also identify the most commonly abused substances in this realm as well as the symptoms (both neurological and physical) linked to every instance of substance abuse. This discussion will also explore the dual diagnosis of anxiety and depression with substance abuse.
The relevance of a discourse of this nature cannot be overstated. This is more so the case given that it is in familiarizing ourselves with the nature of substance abuse in the older population that we can come up with the most effective approaches to reign in the issue.

Slide 3
DSM-5 Definition of Mental Health Disorder
From the onset, it would be prudent to point out that “mental illness can contribute to drug use and addiction” (National Institute on Drug Abuse, 2020). The Diagnostic and Statistical Manual of Mental Disorders (DSM–5) happens to be a detailed classification of numerous mental health disorders, and aims to not only advance diagnostic efforts, but also promote treatment efforts while at the same time aiding research into the same. Towards this end, as a handbook, the DSM-5 has become to be of great relevance in the diagnosis of mental disorders. In the past, DSM has been revised multiple times in an attempt to keep up with new knowledge and research about mental health and wellbeing.
As per the DSM-5 classification, “mental disorders are characterized by problems that people experience with their mind (thoughts) and their mood (feelings)” (Grohol, 2020). It is important to note that as Grohol (2020) further points out, while some of the mental health disorders listed in the said handbook may have causes that are not well understood at present, their symptoms have in the past been scientifically investigated and deemed valid. Some of the mental health disorders afflicting adults, as identified under the DSM-5 classification, are inclusive of, but they are not limited to; alcohol and substance abuse disorders, anxiety disorders, bipolar disorder, depression, schizophrenia, etc. I will discuss three of these in greater detail.
Slide 4
Mental Health Disorders Affecting Older Adults
Health, according to Vendendyck (2018) could be defined as “a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity.” Thus, as WHO further points out, it therefore follows that mental health could be considered part and parcel of health. The impact that mental health disorders could have on the elderly is not any different from their impact on the younger population. As a matter of fact, in some instances, the impact of mental health disorders on the health and wellbeing of older adults could be severe. This is more so the case given that they could make it difficult to treat other chronic illnesses. The number of older adults affected by mental health disorders appears to be on the increase. This is an assertion reinforced by data from WHO (2017) which points out that “approximately 15% of adults aged 60 and over suffer from a mental disorder.” As WHO further observes, as the global population continues to age rapidly, the number of older adults with mental disorders will likely increase significantly. With that said, it is important to note that there are various mental health disorders that affect older adults. On this front, I would like to discuss major depressive disorder, anxiety disorders, and bipolar disorders.
Slide 5
Major Depressive Disorder
As per the DSM-5 criteria, major depressive disorder, as Halverson (2019) observes, is associated with symptoms that last over a period of two or more weeks. It therefore follows that clinical depression differs from mere ‘blues’ or sadness which often last for a few days. For a person to be diagnosed with major depressive disorder, a minimum of 5 symptoms highlighted (under the DSM-5 criteria) ought to be present. Some of the said symptoms are inclusive of, but they are not limited to; loss of interest in a number of activities and/or engagements, indecisiveness and inability to focus or concentrate, loss of energy as well as constant fatigue, retardation and agitation (psychomotor), unexplained weight gain or weight gain, etc. (Halverson, 2019).
Various studies have in the past attempted to assess how major depressive disorder manifests in older adults. For instance, as Graham, Saunders, Flower, Timney, White-Campbell, and Zeidman (2014) observe, major depressive disorder is rather common amongst the older population. As the authors further point out, the said disorder could be rather disabling in this very population. In the words of the authors, in older adults, major depressive disorder “is linked to several negative health outcomes, including a higher risk of cognitive impairment, functional impairment, and development of Alzheimer’s disease and vascular dementia” (Graham, Saunders, Flower, Timney, White-Campbell, and Zeidman, 2014, p. 127). The authors also point out that on this front, major depressive disorder has also been associated with a higher risk of death.
Slide 6
Anxiety Disorders
As Bhatt (2020) points out, as per DSM-5, anxiety disorders are inclusive of all those disorders presenting with excessive anxiety and fear, as well as other behavioral concerns. Towards this end, the author lists some of the anxiety disorders as: medication/substance-induced anxiety disorder, generalized anxiety disorder, specific phobia, selective mutism, and separation anxiety disorder. It therefore follows that the symptoms presented in this case are largely dependent upon the kind of anxiety disorder that a person is suffering.
According to the Anxiety and Depression Association of America – ADAA (2020), “anxiety is as common among the old as among the young.” According to the author, however, the one specific anxiety disorder that happens to be most prevalent among the older population is generalized anxiety disorder (GAD). Those suffering from GAD are likely to experience constant or recurrent feelings of irritability and nervousness, have sleeping problems, and report gastrointestinal disturbances. Further, they are likely to find it difficult to focus or concentrate, and have an increased heart rate. All the symptoms highlighted above are likely to have a severe impact on the health and wellbeing of a person with co-occurring comorbidities. The presenting symptoms could also significantly affect one’s quality of life. Indeed, in the words of Graham, Saunders, and Flower (2014), “generalized anxiety disorder in the elderly increases the risk of physical disability, memory problems, and reduced quality of life — as well as increasing the risk of death” (p. 79).
Slide 7
Bipolar Disorders
In basic terms, this, according to Graham, Saunders, Flower, Timney, White-Campbell, and Zeidman (2014), is a mental health condition that is associated with mood swings that are deemed extreme. As per the DSM-5 criteria, it presents with significant fluctuations in not only the mood of a person, but also their ability to accomplish routine tasks and function normally. Towards this end, there are three distinct conditions under the bipolar disorder. These have been identified as bipolar I, bipolar II, and cyclothymic disorder (Graham, Saunders, Flower, Timney, White-Campbell, and Zeidman, 2014). It is important to note that the authors in this case point out that “to be diagnosed with bipolar disorder, a person must have experienced at least one episode of mania or hypomania” (Graham, Saunders, Flower, Timney, White-Campbell, and Zeidman, 2014, p. 110).
People of all ages could be affected by this particular mental health condition. This is despite the condition being more prevalent in the younger population. Sheehan (2008) points out that in most cases, seniors who are diagnosed with the condition are likely to have had the said condition for decades – only that it could have remained undiagnosed. The symptoms of bipolar disorder among older persons could be somewhat distinct from those witnessed in the younger population. This is more so the case given that as Sheehan (2008) observes, some of the classic mania signs (such as elation) could be absent in this case. However, irritability as well as agitation could be a rather common feature. Seniors suffering from the condition are also likely to exhibit psychosis, confusion, and distractibility. All these have a negative impact on quality of life. This is more so the case given that “seniors with bipolar disorder show significant changes in cognitive functioning, including difficulties with memory, perception, judgment, perception, and problem-solving” (Sheehan, 2008).
Slide 8
Substances Commonly Abused by Older Adults
Substance abuse among older adults is a growing problem. This is despite the fact that little attention has been directed to this particular concern. As I have pointed out elsewhere in this discussion, for most, substance abuse is associated with the younger generation. Indeed, the picture that comes to mind when one thinks of substance abuse or drug addiction is of young or middle aged man with a rugged look. However, research into the concern indicates that drug and substance abuse is also prevalent among older adults. According to Kuerbis, Sacco, Blaer, and Moore (2014), the misconception that there is no drug or substance abuse concern among older adults has been perpetuated by the fact that in the past, very few in this population have presented themselves to substance abuse treatment programs. However, as the authors in this case further observe, “substantial evidence suggests that substance use among older adults has been under-identified for decades” (Kuerbis, Sacco, Blaer, and Moore, 2014, p. 629). Some of the substances that are likely to be abused by older adults include, but they are not limited to; prescription medications, alcohol, and marijuana. These, alongside the neurological as well as physical symptoms associated with each use, will be highlighted in the subsequent sections of this discussion.
Slide 9
Prescription Medications
According to Reimers (2019), one of the most significant concerns in the realm of public health is the addiction to prescription medications among older persons. This, according to the author, is more so the case when it comes to addiction to benzodiazepines and opioids. It is important to note that according to the authors, amongst the elderly, one of the most prevalent concerns – and which has been shown to gradually lead to addiction – is polypharmacy. In basic terms, this could be conceptualized as the utilization of numerous medications on a daily basis (mostly more than 5 medications). Polypharmacy could result in a wide range of adverse reactions. Some of the reactions that Reimers (2019) highlights are disorientation, falls, as well as confusion – and in some instances, death. The author is also categorical that there has been a marked increase in the use of opioids among the older population. In this particular population, the utilization of the said opioids has been associated with “breathing complications, confusion, drug interaction problems, and falls” (Reimers, 2019). Other symptoms associated with opioid abuse could also be inclusive of poor coordination, drowsiness, and euphoria, as well as nausea. In those instances where prescription anti-anxiety medications are being abused, a person could present with symptoms such as memory problems, loss of focus, slurred speech, confusion, etc.
Slide 10
Alcohol
Across populations, alcohol happens to be one of the most abused substances. However, according to Reimers (2019), to a large extent, alcohol abuse is in most cases hidden under the guise of having a good time. This does not, however, lessen the harm occasioned by alcohol abuse. Indeed, in the older population, the adverse effects of excessive consumption of alcohol could be even more severe. To bring this into perspective, it would be prudent to note that as Reimers (2019) points out, “older adults may experience marked intoxication symptoms following ingestion of amounts of alcohol that would be judged safe among younger adults, due to increased effects of alcohol on the central nervous system in the elderly.” There are a number of potential symptoms that could indicate alcohol abuse in older adults. These include solitary drinking (i.e. consuming alcohol in secrecy), extreme irritability and mood swings (especially when sober), short-term memory loss as well as blackouts, decreased interest (or total loss of interest) in undertakings that were previously deemed pleasurable (i.e. hobbies such as reading), slurred speech, etc. Alcohol abuse predisposes older adults to a wide range of other risks that could be detrimental to their health and wellbeing, i.e. falls. It is for this reason that Reimers (2019) is of the opinion that this particular population should avoid the consumption of alcohol altogether.
Slide 11
Marijuana
This is yet another concern among baby boomers. This is more so the case given that as Reimers (2019) observes, recent trends indicate that the use of marijuana happens to be more prevalent among baby boomers than has been the case in previous generations. As the author further observes, those who are most likely to use marijuana are persons who embraced the same (or other drugs) in their youth. It therefore follows that these are the very same persons who are likely to use marijuana in the treatment of, or in the alleviation of symptoms/discomfort associated with conditions linked to old age, i.e. chronic pain.
There are a number of symptoms associated with the abuse of marijuana among older adults. Some of the more common ones are inclusive of; distorted perception, impaired/poor judgment, anxiety, impaired memory, dizziness, as well as impaired coordination. As with alcohol, older persons should abstain from marijuana use. This is more so the case given that there are studies that have in the past indicated that it could have an adverse effect on cardiac health and could pose a significant risk for adverse medication interactions (Grinspoon, 2020). The latter concern is particularly important given that “older people tend to have comorbid health conditions and may be taking multiple medications” (Grinspoon, 2020).
Slide 12
Dual Diagnosis of Anxiety and Depression with Substance Abuse
According to the National Institute on Drug Abuse (2019), “many individuals who develop substance use disorders (SUD) are also diagnosed with mental disorders, and vice versa.” This effectively means that in comparison to the general population, substance abuse is more likely to be reported among those with depression or anxiety. For instance, in as far as anxiety is concerned, Graham, Saunders, Flower, Timney, White-Campbell, and Zeidman (2014) point out that studies have established that there is a link between anxiety disorders and increased rate of lifetime alcohol abuse. The authors further point out that anxiety disorders have also been associated with an increased rate of relapse following rehabilitation for alcohol abuse. This, according to the authors, is as a consequence of more severe withdrawal symptoms that persons with anxiety are likely to experience.
On the other hand, with regard to depression, persons suffering from depression are also more likely to gravitate towards substance abuse – effectively meaning that persons battling or struggling with substance abuse are also likely to be diagnosed with depression. This, according to Graham, Saunders, Flower, Timney, White-Campbell, and Zeidman (2014), is more so the case given that “the symptoms of depression can drive some people toward substance use to cope with their condition” (p. 211). This, in the opinion of the authors, is likely to result in a downward spiral because substance abuse has been known to worsen depression symptoms.
Slide 13
Conclusion
In the final analysis, it would be prudent to note that as has been indicated in this discussion, substance abuse happens to be a serious issue among the older population. This is despite the fact that there has been a misconception that older adults do not engage in substance abuse – leading to the under-identification of this particular concern. However, on the basis of the information that has been presented in this discussion, this is an issue that ought to be apportioned its fair share of attention.
There are various interventions that could be implemented in an attempt to reign in drug abuse among older adults. In my opinion, there is an especially urgent need to address the risk factors for substance abuse in this particular population. Towards this end, it may be necessary to track unaddressed substance abuse concerns that could have taken root from early on. Further, deliberate measures should be taken to ensure that symptoms of depression are treated following diagnosis. This is especially important given that as has been pointed out elsewhere in this discussion, depressive symptoms have been known to drive some persons to drug or substance abuse. This is usually the case as persons attempt to cope with the depressive symptoms.



Slide 14
References
Anxiety and Depression Association of America – ADAA (2020). Older Adults. https://adaa.org/finding-help/older-adults
Bhatt, N.V. (2020, May 7). Anxiety Disorders. Medscape. https://emedicine.medscape.com/article/286227-overview#a2
Grinspoon, P. (2020, April 1). Older adults and medical marijuana: Reduced stigma and increased use. Harvard Health Publishing. https://www.health.harvard.edu/blog/older-adults-and-medical-marijuana-reduced-stigma-and-increased-use-2-2020040119321
Grohol, J.M. (2020, May 22). Symptoms & Treatments of Mental Disorders. Psych Central. https://psychcentral.com/disorders/
Graham, K., Saunders, S.J., Flower, M.C., Timney, C.B., White-Campbell, M. & Zeidman, A. (2014). Addictions Treatment for Older Adults: Evaluation of an Innovative Client-Centered Approach. Routledge.
Halverson, J.L. (2019, Oct. 7). What are the DSM-5 criteria for diagnosis of major depressive disorder (clinical depression)? Medscape. https://www.medscape.com/answers/286759-14692/what-are-the-dsm-5-criteria-for-diagnosis-of-major-depressive-disorder-clinical-depression
Kuerbis, A., Sacco, P., Blaer, D.G. & Moore, A.A. (2014). Substance Abuse Among Older Adults. Clin Geriatr. Med, 30(3), 629-654.
National Institute on Drug Abuse (2020). Research Report: Common Comorbidities with Substance Use Disorders Research Report. https://www.drugabuse.gov/publications/research-reports/common-comorbidities-substance-use-disorders/why-there-comorbidity-between-substance-use-disorders-mental-illnesses
Reimers, K. (2019). Substance Abuse in the Elderly. IPA. https://www.ipa-online.org/news-and-issues/substance-abuse-elderly
Sheehan, J. (2008, Nov 13). Bipolar Disorder in Seniors. Everyday Health. https://www.everydayhealth.com/bipolar-disorder/bipolar-disorder-in-seniors.aspx
Vendendyck, M. (2018). Mental Health and Substance Abuse. https://www.who.int/westernpacific/about/how-we-work/programmes/mental-health-and-substance-abuse
World Health Organization – WHO (2017, Dec. 12). Mental health of older adults. https://www.who.int/en/news-room/fact-sheets/detail/mental-health-of-older-adults