Thursday, September 28, 2017

Substance Abuse and Elders-It's Not Just Pills

Recently Experience, the magazine for the American Bar Association's Senior Lawyers Division, ran a cover story on opiod use and elders.  The Hidden Epidemic: Opioid Addiction Among Older Adults  (subscription required) opens with sobering statistics

Currently the leading cause of injury-related deaths among adults, the opioid crisis has engulfed rural America, spread across our cities, and inundated suburban communities. Despite national alarm, the tidal wave of drug-related deaths continues.

Recent estimates from the National Center for Health Statistics indicate that roughly 52,000 drug-related overdoses occurred in 2015, and more than 60 percent of these were related to prescription opioids or illicit opioid drugs. More telling perhaps is the impact of this carnage on life expectancy, with the United States experiencing its first decline in life expectancy since 1993—the height of the AIDS epidemic.

Let's get more specific, looking at the data regarding elders:

Opioid-related patient visits among adults 65 and older more than doubled between 2006 and 2014, from 28.6 to 70.1 per 100,000, according to data from the Healthcare Cost and Utilization Project Nationwide Emergency Department Sample, which contain nearly one-fifth of all emergency department visits in the country. There’s been a 145 percent increase over the past 12 years.

In 2014, nearly 8 percent of all emergency department visits related to opioid dependence were made by adults aged 65 years and older, representing 36,776 patient visits nationwide, with nearly 70 percent of these visits resulting in hospital admission.

The article discusses risk factors and demographic breakdowns as well as challenges to identifying addiction.  Even ageist attitudes may be at play here.   The article also explains how the opioid crisis case me to be amongst elders. The explanations are interesting and illustrate how challenging it is to tackle this problem.

But opioids are not the only issue. Consider this article from the New York Times from September 14, 2017.  Alcohol Abuse Is Rising Among Older Adults  explains the scope of the situation:

Epidemiologists at the National Institute on Alcohol Abuse and Alcoholism last month reported a jarring trend: Problem drinking is rising fast among older Americans....

Their study, published in JAMA Psychiatry, compared data from a national survey taken in 2001 and 2002 and again in 2012 and 2013, each time with about 40,000 adults. Drinking had increased in every age group, the researchers found.

Those over 65 remained far less likely to drink than younger people — about 55 percent of older participants told interviewers they’d imbibed in the past year. Still, that was a 22 percent increase over the two periods, the greatest rise in any age group.

It's not just the numbers that matter, the article explains. The type of drinking also matters.   "[T]he proportion of older adults engaged in “high-risk drinking” jumped 65 percent, to 3.8 percent. The researchers’ definition: for a man, downing five or more standard drinks in a day (each containing 14 grams of alcohol) at least weekly during the past year; for a woman, four such drinks in a day."  Why is this happening? Some suggested today's elders are healthier so they keep up their drinking ways and they are more comfortable both with drinking and recreational drug use. One thing those folks may not realize--as we age we metabolize alcohol: "With each drink, an older person’s blood alcohol levels will rise higher than a younger drinker’s ... [and] older people have less muscle mass, and the liver metabolizes alcohol more slowly. Aging brains grow more sensitive to its sedative properties, too."  And don't forget medication and alcohol interactions.   The article stresses the importance of diagnosis and treatment.

We are looking at a public health crisis on these issues. How do we best respond?

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