FEARS RISE OF MEDICATION MISUSE BY THE ELDERLY
Prescription-drug abuse and misuse by seniors doesn’t get much attention. But with the senior population steadily growing, it’s getting harder to ignore.
Many seniors develop addictions to prescription drugs. Others are taking medication that is having little effect or unintentional effects, either because they are taking it for too long, they were prescribed too big a dose, or it is reacting badly with other medications.
The misuse of medications “is a rising problem in seniors as the baby-boom generation ages,” says David Oslin, professor of psychiatry at the University of Pennsylvania’s Perelman School of Medicine.
Exactly how much of a problem is unclear, because there isn’t much data available. But it’s enough of a concern that experts in addictions and geriatric care are trying to raise awareness of the issues.
Addiction and Carelessness
For starters: “The use and availability of highly addictive medications continues to rise, with very little recognition of the problem,” says Dr. Oslin.
It isn’t just that doctors sometimes don’t recognize addiction in their patients. Physicians also sometimes fail to recognize the potential for addiction, days James Huysman, a psychologist and a senior clinical consultant at the Hanley Center, a drug treatment center in West Palm Beach, Fla.
“Physicians who work in a fee-for-service system and are traditionally paid by procedure are pressed for time, and too often write prescriptions in the interest of time management without knowing the necessary behavioral health background of a patient,” says Dr. Huysman. That may lead to potentially addictive drugs being prescribed for people who have a history of addiction or who have a high risk for addiction.
Opiates and antianxiety medications are of particular concern, not just for their addictive potential but also because for the dangers that arise when patients simply remain on these medications for too long. Prolonged use of psychoactive medications such as these has been associated with cognitive decline and depressions, according to the Substance Abuse and Mental Health Services Association, an agency of the U.S. Department of Health and Human Services.
Excessive sedation, low respiratory rates, attention impartment, vision problems and loss of motivation are some the side effects common in seniors, according to the agency. Confusion, falls and broken bones can result. Patients may have difficulty carrying out the routine activities of daily living and lose interest in personal hygiene and grooming, and family and friends.
The agency days a doctor’s failure to monitor a patient’s reactions to medications or schedule follow-up appointments should be cause for concern.
The dangers of unintended effects aren’t limited to psychoactive drugs, older men and women frequently are in pain and suffer multiple chronic conditions such as arthritis, hypertension, and anxiety and an inability to sleep. As a result, they are often prescribed a regime of different medications, and the mix has the potential to interact badly. In addition, as people age, the body is slower to metabolize medications, so a dosage appropriate for a younger adult may be too much for an older person.
Experts in senior care are working to raise awareness of the problem among patients and health-care providers. Dr. Huysman gives seminars and speeches to health-care groups around the country on the perils of inappropriate prescribing practices for older patients, and he advises health-care workers on how to recognize the signs of addiction and how to integrate addiction services into medical clinics.
The American Geriatrics Society, meanwhile, is updating it Beers Criteria for determining what medications are potentially inappropriate for seniors, with the aim of helping health-care providers make better decisions.
Others are focusing on getting patients to stop taking drugs that aren’t effective. In one such program, the University of Pennsylvania has joined with a state pharmacy-assistance program aimed at the elderly in an effort to improve results for older patients who have been prescribed antidepressants, antipsychotics and antianxiety medications by non-psychiatrists. Researchers conduct regular follow-up calls to check whether prescribed medications are being taken properly and whether they’re effective.
In its sixth year, the program has worked with more than 2,000 older patients in Pennsylvania. Data are still being compiled and analyzed, but preliminary findings show improvement in symptoms of depression and better overall emotional well-being in program participants.
Dr. Oslin, the Penn professor, who is the lead investigator in the program, says drugs often are misused simply because patients keep taking them long after they stopped being effective, while the underlying health problem-such as depression or obesity-goes untreated.
“Unfortunately,” says Dr. Oslin, “it’s much easier take a pill than to exercise or routinely train health-care workers to properly treat the pain, anxiety, and insomnia often experienced by older adults.”
Ms. Sadick is a writer in New York. She can be reached at firstname.lastname@example.org.