addictions and vices in the elderly

Dangerous Addictions and Vices in the Elderly

There is an addiction crisis in the United States.  It is estimated that well over twenty million Americans over the age of twelve suffer from a substance abuse disorder, which results in an annual loss of over 700 billion dollars to the nation in the form of lost productivity among workers and increased criminal justice and health care costs.

These numbers do not even take into consideration the very real personal toll on families and individuals ruined by substance abuse, nor do they account for additional costs incurred by growing gambling addictions.  One demographic group that many people tend to overlook when thinking about the serious consequences of addiction is the elderly.

This article covers:

  • Substance Abuse in Senior Citizens
  • Causes of Addiction Among the Elderly
  • Alcohol Abuse in the Elderly
  • Signs of Alcohol Abuse in the Elderly
  • Prescription Drug Addictions in Seniors
  • Risk Factors Associated with Prescription Drug Abuse in the Elderly
  • Signs of Prescription Drug Addiction
  • Illegal Drug Abuse Among the Elderly
  • Most Commonly Abused Illegal Drugs
  • Smoking Among Senior Citizens
  • Gambling Among Seniors
  • Gambling Risks for Seniors
  • Signs of Gambling Problems in Seniors
  • Concluding Thoughts
  • Substance Abuse in Senior Citizens

    Abuse of substances like alcohol and drugs are a growing problem among our elderly population. Often under-diagnosed and overlooked, these addictions can go untreated for long periods of time, causing quite a bit of damage to the older adult struggling with them.

    The Office of Alcoholism and Substance Abuse Services classifies substance abuse among the elderly to be one of two categories: “hardy survivor” and “late onset.” Hardy survivors are those who have been abusing for years. Late onset is when an addiction forms later in life.

    Causes of Addiction Among the Elderly

    There are many catalysts, like life-altering events or health issues, that can cause people to begin abusing substances late in life. Here are some possible “triggers”:[i]

    • Death of a cherished loved one or pet
    • Retirement
    • Nursing home placement or relocation
    • Financial struggles or income loss
    • Sleeping troubles
    • Conflict with family
    • Chronic pain
    • Decline in physical or mental health, including memory loss, depression, major surgeries, and more

    Read on to learn about some common substances abused by elderly individuals, how to spot signs of addiction, and how you can help.

    Alcohol Abuse in the Elderly

    You may have noticed that a loved one has started drinking after the death of a spouse or to help them sleep. Over time, they seem to drink more during the day. Or maybe you know an elderly person who has always been a heavy drinker, but he or she seems to be drinking more often.
    These are not uncommon scenarios. Oftentimes caregivers, friends, and family members can overlook drinking concerns in the elderly or mistake issues that arise for other age-related conditions.

    But it is important to be observant and take action if you notice a problem because alcohol can be especially dangerous in the elderly. Why? Here are some general reasons:
    [ii]

    • The aging process affects the way bodies handle alcohol, and as a person grows older, amounts they used to drink when they were younger can now have a greater effect.
    • Additionally, high blood pressure, diabetes, ulcers and other medical conditions can get worse with the consumption of alcohol.
    • Many OTC and prescription medications—even herbal supplements—can become dangerous or even deadly when combined with alcohol. This is especially troublesome for seniors as many of them are on more than one medication a day.
    • Drinking even small amounts of alcohol can negatively impact judgment, coordination, and reaction time. This can lead to falls and accidents around the home or while driving.
    • Elderly individuals who abuse alcohol increase the risk of conflicts with loved ones, caregivers, and others around them.

    Signs of Alcohol Abuse in the Elderly

    Common signs of alcohol addiction to watch for include the following:

    • Using alcohol to forget worries, calm down, or deal with feelings of depression
    • Often consumes more than one drink per day
    • Starts to drink more to get high
    • Harms others or self while drinking
    • Becomes irritable when not drinking
    • Experiences social, health, or financial problems due to drinking

    If a senior you know is suffering from alcohol addiction, it is never too late to get help. Contact your local health department or social services department to learn about treatment programs available in your area.

    Prescription Drug Addictions in Seniors

    It is an all too common story. An elderly person is prescribed a medication to deal with age-related problems like anxiety, depression, pain, or insomnia. But over time, the meds just don’t work as well, so he or she takes a larger dose to manage the pain.

    Worried that a care physician will stop filling the prescription and afraid to live without it, the person begins seeing other doctors to obtain the same prescription, which is then filled at different pharmacies. At this point, without even realizing it, addiction sets in.

    Prescription drug misuse falls into four drug categories:

    1. Painkillers: Opioid pain killers like hydrocodone, morphine, and oxycodone relieve pain and can elicit euphoric feelings in larger doses, similar to illegal opiates like heroin. These are considered the most dangerous and addictive painkillers available and are misused more than any other prescription drug. Elderly individuals taking opioids are at a higher risk for falls and fractures, pneumonia, delirium, and all-cause mortality.
    2. Tranquilizers: Often used to lower anxiety or stress, tranquilizers like benzodiazepines suppress the central nervous system. Although very addictive, these drugs are misused at a much lower rate than opioids among the elderly. Seniors taking tranquilizers can experience motor coordination problems associated with falls. Research also points to evidence of higher risk for cognitive impairment.
    3. Sedatives: Similar to tranquilizers, sedatives relax the body and are frequently used to treat sleep disorders, stress, and anxiety—all common problems in this age group. While sedative misuse is relatively low, it can be quite addictive. Risks for the elderly include loss of balance and dizziness which can contribute to falls. Overdose can cause a slowed heart rate resulting in death.
    4. Stimulants: Stimulants increase alertness and energy and can cause euphoria. Due to the high risk of addiction and abuse, stimulants like methylphenidate (Ritalin) and amphetamine (Adderall) are much less prescribed to the elderly than they were in the past. Stimulants increase heart rate and blood pressure, which leads to higher cardiovascular problems, posing a serious threat to seniors.

    Risk Factors Associated with Prescription Drug Abuse in the Elderly

    While misusing prescription drugs can be harmful to any age group, it poses a special threat to older adults. Here are some reasons why: [iii]

    • Given the fact that over 80% of elderly individuals live with more than one chronic condition and have higher rates of certain disorders (e.g. anxiety, sleep, pain), they are typically on more than one medication at a time. Taking more than the prescribed dose of a medication, or mixing the med with other drugs or alcohol, can cause an accidental deadly overdose, even when abuse isn’t a factor.
    • Seniors taking more than one medication can have difficulty remembering to take their meds in the right doses at the right times.
    • Vision and hearing loss as a result of aging can make reading and understanding instructions for medications difficult.
    • Elderly individuals suffering from serious health problems may turn to medications to cope with anxiety, depression, or pain that accompany those problems.
    • Fluctuations in weight, metabolism, and body fat can change the way medication works in the body, heightening the risk for misuse.
    • When mixed with alcohol, severe adverse reactions can occur because the elderly metabolize more slowly.

    Signs of Prescription Drug Addiction

    Here are some common behaviors you might observe in a senior with a prescription drug abuse problem:

    Changes in mood or behavior. Has the person become more secretive, anxious, withdrawn, or aggressive?
    Consuming more pills per day. Has he or she been taking more pills than usual? Check bottles to verify dosages.
    Past treatment for substance abuse. Has the individual been treated for substance abuse in the past?

    Change in care providers. Has the person recently started seeing other doctors or visiting other pharmacies?

    Duplicate prescriptions. Does the senior have the same prescription from more than one physician?

    Keeping an emergency stash. Does the individual have an on-hand supply in his or her purse or pocket?

    Taking medications secretly. Does he or she hide or sneak medications?

    Avoidance of conversations regarding medications. Does the person get agitated or uncomfortable when asked about his or her use of prescription meds?

    Prescription drug addiction can be difficult to catch in the elderly population. Caregivers on the front lines can help by being diligent in making sure medications are taken safely and in the proper dosage. If you think you know an elderly person caught up in prescription drug addition, get in touch with the physician prescribing the med to come up with a viable solution.

    Illegal Drug Abuse Among the Elderly

    Illegal drugs may not immediately come to mind when you consider drug abuse in the elderly, but it is a very real problem.

    Ninety percent of illicit drug abuse among seniors is early-onset, meaning it is occurring in people who have been abusing since youth or middle age. The remainder of seniors misusing illegal drugs are considered late-onset users.

    Like other drugs, these have severe physical and social implications, which become worse with long-term use. The medical risks are compounded when these drugs are mixed with alcohol or prescription drug use.[iv]

    Most Commonly Abused Illegal Drugs

    Marijuana:

    Marijuana is the most commonly used illegal drug and the second most commonly abused substance behind alcohol in senior citizens. Cannabis is typically a late-onset vice among seniors to help cope with stress, anxiety, or pain. Because of its varied effects, it is considered both a stimulant and depressant.

    Risks associated with marijuana are centered around its cognitive effects, including:

    • Higher latency times
    • Decreased ability to respond to stimuli
    • Negative effects on respiratory, cardiovascular, and immune systems
    • Higher risk of cardiac morbidity

    Cocaine:

    Cocaine is a powerful stimulant which is inhaled or injected.  While late-life cocaine use is relatively low among the elderly, experts note that use is trending upward. Cocaine is especially harmful to seniors because they are predisposed to many of its most dangerous effects.

    Cocaine use in seniors raises the risk of the following medical problems:

    • Cerebrovascular accident
    • Myocardial infarction
    • Heat stroke
    • Delirium
    • Cognitive impairment
    • Hypertension
    • Pulmonary issues
    • Overdose

    Heroin:

    In recent years, the opioid conversation has been focused around prescription opioid abuse. However, heroin, an illegal narcotic derived from morphine, has long been the drug of choice among elderly early-onset heroin abusers. Heroin affects pain perception and using it creates pleasurable feelings and diminishes pain.

    Some of the risks of heroin use in the elderly include:

    • Decreased mental capacity
    • Higher risk for falls and fractures
    • Chronic pneumonia
    • Liver, kidney, and skin diseases
    • Blood clots leading to major cardiac events
    • Delirium
    • Seizures
    • Overdose
    • All-cause mortality

    If you suspect that an elderly loved one is addicted to an illegal drug, contact his or her primary care provider immediately to determine the best treatment options.

    Smoking Among Senior Citizens

    For many seniors, smoking is a way of life—something they may have done since they were teens. Many people ask if family members or caregivers should even try to get them to quit or allow them to enjoy the habit.

    While the argument can be made that smoking and nicotine addiction is not as dangerous as substances like opioids or even alcohol, smoking does have its health risks, and smoking-related diseases do hit the elderly population especially hard because of their cumulative effect over time.

    These risks include: [v]

    • Chronic obstructive lung disease
    • Cardiovascular disease
    • Cancers
    • Respiratory problems
    • Increased old-age diseases like diabetes, osteoporosis, etc.
    • Increased smoking-related mortality risk
    • Much more

    It’s important to remember that it is never too late to quit smoking, and the risk of mortality can be significantly reduced even when a person quits in the later years of life.

    By working with caregivers and a senior’s medical team, you can develop a successful plan to address your loved one’s nicotine addiction.

    Gambling Among Seniors

    If you pay a visit to a casino on any given day of the week, you will see a clientele that might surprise you: senior citizens occupying slot machines, placing bets on horse races, and playing other games.

    Casinos, being the opportunists that they are, have begun catering to this segment of the population by running “senior day” promotions and offering discounts and freebies to get the elderly population in the door. Many casinos even go so far as to supply scooters, oxygen tanks, adult diapers, and shuttle services from local senior living facilities.

    So what’s wrong with visiting the casino as a form of entertainment and socialization? Nothing, if enjoyed moderately. In fact, there are studies that indicate those who gamble recreationally enjoy better mental and physical functioning than their non-gambling peers.

    However, a study that surveyed senior living facilities revealed that gambling facilities were the most frequented day-trip social activity with 16% of seniors taking part in trips to the casino on a monthly basis.[vi]

    Gambling Risks for Seniors

    Many experts are concerned that gambling poses a unique threat to elderly individuals. Due to the loss of spouses and friends and the transition to retirement, seniors can be especially vulnerable to a syndrome called “grief gambling.”

    Grief gambling, which is gambling as an escape from feelings of isolation and sadness, accounted for roughly one-quarter of gambling seniors according to a recent survey.

    Here are some additional reasons why gambling can be risky:

    Fixed incomes. Seniors have more to lose than other age groups since many of them live on fixed incomes, preventing them from recouping money spent on gambling losses.

    Impaired judgement. Often, seniors are dealing with anxiety/mood disorders, cognitive impairments, or are on medications which can impair judgement.

    Addiction to gambling. Pathological gambling, where the elderly individual has trouble controlling or quitting gambling habits, is an addiction. Experts estimate that around 4 million seniors are currently dealing with serious gambling problems, and that is recognized as a low estimate.

    Signs of Gambling Problems in Seniors

    With gambling becoming increasingly popular, it’s important to recognize when gambling has crossed the line from recreation to addiction.

    Here are some things to watch for: [vii]

    • Financial problems linked to gambling
    • Lying about or downplaying gambling habits
    • A loss of interest in loved ones or favorite activities
    • The avoidance of discussions about money or time unaccounted for
    • Missing assets or possessions
    • Depression
    • Listlessness
    • Perseverating on gambling
    • Increased frequency in the need to gamble to recapture the rush previously felt
    • Signs of health issues including headaches, bladder or bowel problems, and lethargy

    If an elderly person you know is struggling with a gambling addiction, there are several organizations that can help, including Gamblers Anonymous and Gam-Anon.

    Concluding Thoughts

    As baby boomers age, our elderly population grows larger and with it comes a higher incidence of addictions and vices among senior citizens.

    As caregivers and family members, we are on the front lines when it comes to spotting the warning signs of addiction. If you suspect a problem, get in touch with the senior’s physician to determine what screenings or tests can be done to confirm the addiction.

    With the proper diligence and compassion, we can help provide the best care and quality of life for the seniors we care for.

    [i] https://www.addictioncenter.com/addiction/elderly/

    [ii]https://www.agingcare.com/articles/alcohol-abuse-elderly-parents-133827.htm

    [iii] https://www.aarp.org/content/dam/aarp/ppi/2017/07/prescription-drug-abuse-among-older-adults.pdf

    [iv]https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3505129/

    [v]https://mdquit.org/special-populations/older-adults

    [vi] https://www.ncbi.nlm.nih.gov/pubmed/11310572
    [vii]https://seniorcareadvice.com/virtues-and-vices-of-gambling-among-seniors.htm
    [viii]https://seniorcareadvice.com/virtues-and-vices-of-gambling-among-seniors.htm