Transcript Making Prevention Work for Older Adults

Pain of aging
Making Prevention Work for
Older Adults
Program made possible through collaboration of the
HANDS foundation and Cornerstone Wellness Center, INC,
through a grant from the Medina County Drug Abuse
Commission
What you see is what
you get??
 M.A.
Ph.D.
B.S.
M.D.
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Fact versus fiction
Separating the truth from misconception
Understanding older adults and issues with :
medication use, misuse and abuse
unique vulnerability to medication, alcohol, and other drug use
problems
Over-the-counter and herbal remedies
Opiate use in Ohio
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Drug overdoses have increased in Ohio by 372% from 1999 to
2010
Prescribed opioids such as Oxycontin and hycrocodone(Vicodin)
are involved in more overdose deaths than heroin and cocaine
combined
3 of 4 overdoses caused by Rx painkillers
30% in age group 45-54; 11% in age group 55-64; and 3% in
over 65 age group (47% of overdoses in over 45 age range)
Source: Ohio Department of Health, vital statistics
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And now……
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Opiate use nationally
 159% increase in ED visits for those 50+ (2004-2009)
involving pharmaceutical misuse/abuse
 45% increase seen in older adults between 2008-09 in
ED visits involving oxycodone
 2009-LARGEST percentage of ED visits (33%) involving
misuse/abuse of pharmaceuticals were among 50-54
year olds
 About half of ED visits for pharmaceutical misuse/abuse
occurred in women
Source DAWN Report, July 26, 2012, SAMHSA
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Prevalence of opiate use
 Opiates began to be prescribed for chronic pain
 In 2007, 32% increase in dispensing to adults
60 and older (double the growth for
prescriptions in the 40-59 age group)
 Increase in direct marketing to consumers
 Many of the practitioners leading the way to
increased use of these drugs for chronic pain
receive money from the drug companies who
make the drug
Source: www.medpagetoday.com, retrieved September 14, 2012
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Aging in America
 The 65+ U.S. population=37.3 million in
2006, and increase of 3.4 million or 10%
since 1996
 About 1 in every 8, or 12.4% of the
population is an older American-by 2025,
one in 5 will be over 65
 About 30% of the non-institutionalized
older persons live alone
 Almost half of older women (48%) live
alone
Source: Administration on Aging, A Profile of
Older Americans, 2007
Ohio Is Changing
 12,000 Ohioans turn 60 each month
 85+ population will increase by 40%
in 7 years
 By 2050 one million Ohioans will be
over age 85
 50% of those over 85 will experience
dementia,
Source: Ohio Department of Aging
Changing In Aging
 Among Ohioans age 60 and older, the dramatic
growth has been among those 75 and older.
The largest gains have been in suburban
counties adjacent to larger urban areas
 Only about 4.5% of all older Ohioans are in a
nursing home, a droop of over 1% from 2000.
Many elders are living in the community with
support from family and home health services.
 Life expectancy in 1900=46.3/48.3
(men/women)
 Life expectancy 2010=75.7/80.8
Source: Ohio Department of Aging/CRS Report for Congress Life
expectancy in the U.S.
The NEW normal…..
 2/3rd’s of those who have EVER lived beyond
65 years, are LIVING NOW
 Medical advances contribute to longer life,
healthier life, older ages
 Never before have humans experienced the
longevity of today
 Medical science, economies, our world, our
addiction treatment centers are
UNDERPREPARED for the needs of our aging
population
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What’s in a number?
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Mick Jagger-69
Bruce Springsteen-63
Paul McCartney-70
Judy Collins-73
Meryl Streep-63
Bruce Jenner-62
Stephen King-65
Sophia Loren-78
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What’s in a number?
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Is this old……
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Or this?
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Stones then….
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1960s….
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And now……50 years later??
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Prevent WHAT?
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Older adults are frequent users of prescribed and OTC
medications
Prevalence of illicit drug use is on the rise, with the aging of
the “baby boomer” generation (1946 – 1963)
Changes associated with aging serve as both risk factors for
substance misuse and are aggravated by substance use
Existing diagnostic criteria for substance use disorders may
miss or under identify older adults substance use disorders
Today’s older adults did not receive prevention education
growing up
Older adults may be difficult to assess due to
perceptual/cognitive issues
Hepatitis C
Prevalence of chronic pain
 Up to 50% of community dwelling adults 65 and older,
have pain that interferes with normal daily living
 Prescription pain medication use is associated with the
frequency/severity of pain
 Those treated with pain medication-both Rx and OTC,
86% still experienced pain
Source: Sawyer, et.al., 2006. American Journal of Geriatric
Pharmacotherpy
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Overview: Vulnerability
 Overrepresented in number of
prescriptions
 Physiological changes increase drug
sensivity
 Physical changes collide with drug
effects
 Unlikely to have prevention education
 Underidentified and pain undertreated
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Abuse of alcohol and prescription drugs among older
adults 60 and older is one of the fastest growing health
problems today. TRUE
 2.5 million older adults have problems related to
alcohol.
 Estimates suggest that by 2020, that number will
reach 5 million.
 Older people are hospitalized more frequently for
alcohol related problems than for heart attacks.
 The drug of first choice in the older population is
TOBACCO. Tobacco use is associated with
development of Alzheimer’s disease in individuals
WITHOUT genetic predisposition. The number two
drug is alcohol.
 20% of older adults receiving treatment for medical,
surgical or psychiatric difficulties are alcoholics or
problem drinkers
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Older adults consume more prescribed and over the
counter drugs than any other age group. TRUE.
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Only 17% of the population, older adults, consume 34% of
all prescribed medication and 30% of all over the counter
drugs. prescription drugs.
Many older adults consume multiple medicines at the same
time. A study of 17,000 Medicare beneficiaries found that 2
out of 5 patients reported taking five or more prescription
medicines.
Of people over age 65, 83% take some prescription and
over half of all prescriptions for older persons have some
sedative.
As the number of prescriptions increases, so does the
possibility of misusing, Esp. if over 7 medications
Almost 40% of seniors are unable to read prescription
labels and 67% are unable to understand information give
to them
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Opiates and elderly
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Number of older Americans seeking treatment for opiate abuse
increased from 6.8% to 12% (1995-2002)
Source: SAMHSA, retrieved from www.about.com, 9/14/2012
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Use of opioids found to:
 Increase the risk for fractures
 Increase the risk for all cause mortality (oxycodone) after
30 days
 Increase cardiovascular risk (codeine) after 180 days
Source: Solomon, 2010. Archives of Internal Medicine
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Treatment help is NEEDED
 By 2020, number of adults 50+ in need of substance
abuse treatment is expected to double from 2.8 million
(average 2002 to 2006 annual average) to 5.7 million
 National Survey of Substance Abuse Treatment Services
(N-SSATS) showed in 2009 FEWER facilities offer special
programs or groups for older adults than in 2004
Source: DASIS, 2012
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Many over the counter medicines have
harmful interactions with alcohol and other
prescribed medicines, especially narcotics and be
benzodiazapines. True
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Aspirin
Seroquil
Benadryl
Ohio Vital Statistics reports that
multiple drugs are often found in OD
deaths-77% of OD deaths in 2010
related to multiple drugs
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The normal process of aging increases older adults
vulnerability to the development of a problem with alcohol and
to other medications, including pain medication.
TRUE.
 Fall in ratio of body water to fat-less water
for the alcohol to be diluted in
 Decreased hepatic blood flow-liver will
receive more damage
 Altered responsiveness of the brain-alcohol
will have a faster effect on the brain
 Inefficiency of liver enzymes-alcohol will
not be broken down as efficiently
 Baby boomers at increased risk for
Hepatitis C
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Only people who display drug seeking behavior –stealing
other’s medication or buying it on the street or use
up their medication before the refill is due have
a real problem. FALSE.
 False security in normalizing “physical
dependence” or downplaying the
addictive potential of opiates and
benzodiazepines
 It’s not how much or how often, it’s
how it effects you. Older adults are a
vulnerable group!!!
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Alcohol and medication misuse is easy to identify
in older adults. FALSE.
 Medication/alcohol misuse/abuse MIMICs the normal
signs of aging, conditions commonly diagnosed in
older adults (dementia) Common signs of aging:
forgetfulness, mental confusion, shakiness, unsteady
movement, loss of coordination, sleeping more or
having difficulty sleeping
 Often times the misuse/abuse is unintentional, related
to lack of knowledge about risk of interactions and of
impact of aging physiology on part of BOTH the
consumer and caregiver
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Physical Symptom Screening
Triggers
 Sleep complaints, changes in sleep patterns,
daytime sleepiness, unusual fatigue
 Cognitive impairment, memory or concentration
disturbances, disorientation or confusion
 Seizures, muscle wasting, malnutrition
 Liver function abnormalities
 Persistent irritability and altered mood,
depression, and anxiety
 Poor hygiene and self-neglect
 Unexplained complaints about chronic pain or
other somatic complaints
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Physical Symptom Screening
Triggers
-Incontinence, urinary retention, difficulty
urinating
-Unusual restlessness and agitation
-Complaints of blurred vision or dry mouth
-Unexplained nausea and vomiting or GI
distress
-Changes in eating habits
-Slurred speech
-Frequent falls and unexplained bruising
-Tremor, motor uncoordination, shuffling gait
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DSM-IV Diagnostic Criteria and
Older Adults-Special Consideration
 Tolerance-Older adults my have problems
with even low intake due to increased
sensitivity to alcohol an dhigher blood
alcohol levels
 Withdrawal-Many late onset alcoholics do
not develop physiological dependence
 Progression-Increased cognitive impairment
can interfere with self-monitoring; drinking
can exacerbate cognitive impairment and
monitoring
 Efforts to cut-down/quit-Same issues
across the lifespan
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DSM-IV Diagnostic Criteria and
Older Adults-Special
Consideration
 Time seeking, using, and recovering from
effects-Negative effects can occur with
relatively low use
 Giving up activities due to use-May have
fewer activities/responsibilities, making
detection of problems more difficult
 Continued use despite
physical/psychological conditions made
worse-May not know or understand that
problems are related to use
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A person’s primary care physician would be able to tell
a person if he or she had a problem with alcohol and /or
medication. FALSE.
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Symptoms of substance use disorders often are overlooked
or misdiagnosed as depression, dementia, and other health
problems associated with aging. Alcohol abuse creates and
exaggerates medical and psychological problems.
Many older adults see more than one physician, may not
inform physician of all medications being taken, including
OTC medication
Questioning patients about alcohol consumption may not
occur-health care professionals tend to see changes in
mental and physical health status, but do not address the
possibility of alcohol abuse/addiction as a cause of these
changes.
Opioid manufacturers market their products for uses
that they lack solid scientific data on the
effectiveness and safety for older adults
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It is recommended that older adults consume no more
than one alcohol containing beverage per day, and women
should consume one or less. TRUE.
 It is recommended for adults over 65-no more than
one per day for men, and less if you are a woman
AND are not taking any other prescribed medicine nor
have any health condition that is exacerbated by
alcohol use
 “A glass of wine a day is good for your heart health”use of 2-3 beers at age 65 can have the same effect
as drinking 7-8 beers at age 20 83% of people over 65 take AT LEAST one
prescription drug, over half of which, are some kind of
sedative
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Even if you think someone you care about has a problem
with alcohol or misuse of medicine, you should never say
anything about it to him or her. FALSE.
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Older men are about four times as likely to have alcohol problems
than older women, but older women are more likely to drink alone.
Widowers over 75 have the highest rate of alcoholism in the
country. The older depressed alcoholic is the person at highest
risk for committing suicide in this country.
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THE MORE MEDICATIONS A PERSON TAKES THE GREATE THE
RISK OF MISUSE, WHETHER INTENTIONAL OR ACCIDENTAL
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The number of older adults who abuse alcohol is predicted to more
than double in the next 50 years because of the projected size of
the older population and because future generations of older
people are predicted to have more liberal attitudes toward alcohol
consumption.
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Sense of Loss
 Changes occur in the transition from middle to older
adulthood and affect many life areas
 Many older adults are coping with loss:
-loss of spouse, or family/friends
-retirement and possible loss of income and job
related social supports
-loss of structure and professional identity that
work provides
-Illness that leads to impaired/loss of sensory
abilities, like vision, hearing, or mobility
-change/loss of independence
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“Any symptom in an elderly
patient should be considered
a drug side effect until
proved otherwise.”
J. Gurwitz et al.; Brown
University, 1995
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References
 Bartels, S.T., Blow, F.C., Brockmann, L.M.,
VanCitters, A. August, 2005. Substance
Abuse and Mental Health Among Older
Americans: The State of the Knowledge
and Future Directions. Prepared for the
Older American Substance Abuse
andMental Health Technical Assistance
Center and Mental Health Services
Administration, Rockville, Maryland
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References
 Substance Abuse Among Older Adults
TIP 26, U.S. Department of Health
and Human Services, SAMHSA,
Center for Substance Abuse
Treatment
 Center for Substance Abuse
Prevention, Prevention Pathways,
online education for caregivers and
professionals:
www.pathwayscourses.samhas.gov
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References
 Older Americans Substance Abuse & Mental
Health Technical Assistance Center,
Professional Reference Series: Prevention
of Alcohol Misuse in Older Adults;
Prevention of Medication Misuse in Older
Adults. www.samhsa.gov/OlderAdultsTAC
 Institute of Alcohol Studies, www.ias.org.uk
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Contact us
 Cindy McQuown, Cornerstone
Wellness Center, Co-Director,
[email protected]
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