The elderly and addiction
Healthcare system faces challenges caring for addicted seniors
As the 50-plus cohort is now nearly entirely made up of the baby boomer generation, the issue of addiction among seniors has started to garner some attention. A report released in 2009 by the Substance Abuse and Mental Health Services Administration (SAMHSA) found that from 2002 to 2007 there was a rise of illicit drug use among those ages 50 to 59. A larger population of elderly patients with substance abuse issues will challenge the healthcare system say those in the field.
“The reason we’re seeing the increase in this number is really a cohort effect. The bulk of these people have been using drugs for a good part of their lives, it’s just they’re older,” said Peter Delany, PhD, director of SAMHSA’s Center for Behavioral Health Statistics and Quality. “The healthcare system is going to be challenged because they’re going to need to make sure they’re screening for these issues. If you go into any doctor’s office now, they may ask you about your alcohol use and they may ask you about your smoking. Not very often are they asking you about drug use.”
Knowing which substances are being used by patients – including prescription and nonprescription drugs – is important in this age group because some drugs can interact with medications prescribed to treat chronic illnesses often found among the elderly, like high blood pressure, heart disease and diabetes.
“It is easy to speculate that morbidity from falling, cognitive impairment and interference with a wide variety of medicines for chronic diseases, lead to increased costs from the complications of care,” said Oreste Arcuni, MD, addiction medicine director of High Watch Recovery Center in Kent, Conn. “Add to this the very high risks of adding alcohol to the mixture, even in small amounts, and the probability of untoward medical and surgical events increases exponentially.”
“Unless dramatic changes are made in the way we screen for and treat addictive disorders within the next few years, I do not think the current Medicare system will be able to withstand the burden of the baby boomers' future healthcare needs,” said Jason Schiffman, MD, psychiatrist at the University of California Los Angeles Semel Institute for Neuroscience and Human Behavior and editor in chief of Anxiety.org.
“Substance use disorders manifest differently in older adults than in younger individuals, and the criteria that are used to diagnose these disorders may actually end up inappropriately excluding elderly patients with serious substance use problems,” Schiffman said.
To minimize medical complications due to substance use, doctors need to screen their elderly patients, Schiffman and others in the field stressed.
Screening is inexpensive and relatively painless: a series of questions and maybe a urine drug test.
“Given how many of our automobile accidents, fires, and crimes are related to addictive illness, the small expense for screening is trivial,” said Stuart Gitlow, MD, acting president, American Society of Addiction Medicine and executive director, Annenberg Physician Training Program in Addictive Disease. “Surely a frequently-intoxicated elderly person should be identified prior to their falling off their front stoop and breaking a hip.”
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