Treatment for the Elderly
As a group, elderly individuals have relatively low rates of substance use disorders compared to other age groups; however, as individuals grow older, they may face a number of specific life challenges. Getting older results in various changes, such as changes in life obligations, changes in health, and even changes in one’s circle of family and friends. Some of the major issues that are associated with an increased probability of developing a substance use disorder in elderly individuals include:
- Feelings of isolation and/or loneliness as a result of the loss of a partner, other relatives, or members of one’s social support group, leading to clinical depression
- Decreasing physical health
- Poor coping skills.
Of course, individuals who have developed substance use disorders earlier in life and continue to engage in use of drugs or alcohol will most often continue to display issues with substance abuse as they age because these symptoms do not spontaneously remit. The probability of developing a substance use disorder as one gets older is also increased if one has another mental health issue, such as a diagnosable mental health disorder or even subclinical issues, such as depressive symptoms, anxiety, or feelings of poor self-worth.
Signs of Substance Use Disorders in the Elderly
While the formal diagnosis of any substance use disorder is made according to specific criteria that are applied to all age groups (e.g., the diagnostic criteria of the American Psychiatric Association), there are some signs specific to individuals over the age of 60 that may indicate there is a problem with a substance use disorder:
- Solitary or secretive use of alcohol or a ritual of having alcohol before, during, and after meals
- Drinking alcohol in conjunction with using prescription medications
- Frequent use of pain medications or benzodiazepines
- Increased isolation, decreased attention to grooming, frequent falls, and/or noticeable slurred speech that is not associated with a neurological issue, such as a previous stroke or with dysarthria (a condition that causes speech to be labored)
- Suddenly making complaints about one’s health that are unsupported by medical evidence
- A demonstrable loss of interest in activities that the person once took interest in, such as hobbies, socializing with others, doing chores around the house, etc.
- Displaying signs of irritability, hostility, or even depression
- Issues with cognitive functioning, such as memory loss
It should be noted that some of the above symptoms may also signal the onset of another process, such as stroke or dementia. However, substance abuse is an often overlooked issue in the elderly. In addition, misuse of substances where the individual takes their medications in a manner that is inconsistent with their prescribed uses or is getting too many medications from different doctors is also an issue with the elderly. These factors may result in the development of substance abuse issues in elderly individuals.
Some elderly individuals may have issues with cognition that complicate their ability to safely take their medications. They may forget that they took the medications and take too much of the medication, not follow the prescribing instructions (e.g., take medications that should be taken with food on an empty stomach), and mix medications that should not be mixed (e.g., taking a benzodiazepine in conjunction with narcotic pain medications). These issues may exacerbate the potential for the development of a number of different substance use disorders in this group.
- The most common form of substance use disorder in elderly individuals is alcohol use disorder.
- Benzodiazepines, drugs that are prescribed for anxiety, seizure control, or to induce sleep, are the most misused and abused prescription medications in elderly individuals.
- The combination of alcohol and benzodiazepines can be particularly serious for anyone, and the potential dangers of taking these drugs together are increased in the elderly.
- One of the highest rates of alcohol use disorders occurs among individuals over the age of 75 who have lost their partner.
- There may be high rates of substance use disorders among nursing home residents, and as many as 2.5 million elderly individuals may have a substance use disorder.
- A significant percentage of hospital admissions associated with elderly individuals may stem from alcohol or drug abuse or misuse.
Treatment for Elderly Individuals
NIDA reports that elderly individuals respond just as well to standard treatment protocols for substance use disorders as other groups. When seeking treatment for an elderly individual, keep the following in mind:
- No one treatment works or is an appropriate program for all individuals. While there are a number of different approaches to treating substance use disorders that have empirical validation, there is no specific “one-size-fits-all” treatment approach. It is important to match the treatment with the individual client. For instance, elderly individuals may be resistant to seeing a psychotherapist or counselor. The use of therapy for these individuals often needs to be explained and/or delivered in a sensitive manner.
- The treatment needs to be available. Elderly individuals have a number of restrictions that may keep them out of certain forms of treatment. If the treatment is not available, it cannot be useful. If the individual does not attend treatment, the treatment cannot be effective.
- Elderly individuals as a group have specific needs. Successful substance use disorder treatment must address the needs of the individual. Treatment should be appropriate for the individual’s age, cultural background, and medical condition.
- Effective substance use disorder treatment meets the special needs of the person. Elderly individuals are often isolated, feel lonely, or may have some cognitive issues. Effective substance use disorder treatment addresses the specific needs and capacities of the individual.
- Treatment must continue for an adequate period of time in order for it to be effective. There is no “quick fix” approach to treating a substance use disorder. Keeping elderly individuals engaged in treatment programs is a key issue to their success.
Getting elderly individuals to participate in group therapy that consists primarily of other elderly individuals may be the key to getting someone with an issue into treatment. Personalizing the treatment approach according to the person’s age and background is also a key factor in getting the individual involved in treatment. In addition, the use of medically managed treatment approaches for elderly individuals should be delivered in the same manner and according to the same needs as with individuals in other age groups.
Overall, there are several major considerations that apply to increasing the effectiveness of treatment protocols focused on elderly individuals. These include:
- Understanding the effects of medications and alcohol: The use of prescription medications and alcohol by elderly individuals results in significantly different effects than what occurs in younger individuals. Older individuals often need lower doses of prescription drugs for medicinal reasons and respond differently to alcohol and drug usage than do younger individuals. Medication use in elderly individuals often needs to be controlled and monitored closely.
- An increased need for public awareness and identification: Substance use disorders cannot be treated unless they are identified in individuals. There is an increased need for public awareness regarding substance use disorders in elderly individuals and the identification of the potential signs and symptoms of substance abuse by elderly individuals by physicians, relatives, peers, caregivers, etc. The use of screening and diagnostic tools for the detection of substance use disorders should be increased among caregivers and treatment providers of elderly individuals.
- Increased access to care: There remains a relative shortage of behavioral healthcare service providers who are trained to serve older adults. There is also a shortage of behavioral healthcare programs designed specifically for elderly individuals. These services need to be increased.
- Integrating substance use disorder treatment of primary care: Because many elderly individuals with substance use disorders do not readily attend therapy or support groups, it is important that primary care for these individuals also incorporates substance use disorder treatment.
- An increase in research: Increasing research efforts to identify effective assessment tools and treatment protocols specifically designed for elderly individuals is an extremely important aspect of serving this population.
- Integrated treatment protocols should be implemented for this population: Because the available evidence suggests that a large number of elderly individuals who develop substance use disorders have co-occurring conditions, such as depression, issues with anxiety, feelings of isolation, and other potential mental health disorders, it is extremely important that all of these issues be treated concurrently. An integrated treatment program for these individuals should address the individual’s substance abuse issue and any co-occurring issues concurrently. Such a program should also involve the use of a multidisciplinary treatment team that includes physicians, therapists, social workers, case managers, and other treatment providers who work with the individual across a number of different domains.