Is it memory impairment, a medical issue or addiction?

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Scott Trout
Scott Trout

Alcohol and drug abuse is a somewhat hidden problem in the eldercare arena, as many caregivers and medical professionals fail to recognize it for what it is.

Symptoms such as memory problems, confusion, dizziness, an unsteady gate and tremors can be part of misdiagnoses by medical professionals who believe they are signs of dementia or other age-related medical issues. As a result, many of the older adults who need help with substance abuse do not receive the advice and treatment they truly need.

Why are seniors at risk for addiction in retirement?

Many people probably think that if a person is going to suffer from addiction, it will be a problem that starts in adolescent years or young adult life, not something that happens in the 70s or 80s. By then, one should know better, right? For some seniors, however, it's not a matter of knowing better. Medicines that are supposed to be “OK” because they are approved by doctors wind up becoming vehicles for the self-medication of unwanted feelings.

The increase we're seeing in addiction in post-retirement stems from two main causes: seniors are becoming addicted to opioid-based pain medication, which is being prescribed with leniency, or seniors are using alcohol or other drugs to combat psychological problems such as depression or anxiety, which could stem from feeling a loss of purposefulness, loneliness or other life stressors that come with aging and retirement.

Unfortunately, not all seniors flourish in their retirement. As they age, many may feel as if they have lost their sense of purpose. They might experience feelings of isolation, boredom, anxiety caused by poor health, or depression after the death of a spouse or child. Poor health can stem from a variety of issues, such as high blood pressure, diabetes or another chronic illness; reduced organ function; and a host of other factors.

The problem is that when you combine these kinds of health conditions or psychological issues with an active addiction, it makes treating that individual a complicated and risky venture. We call this a dual diagnosis — working to determine what the person is addicted to and what psychological problems may have induced this need to cope with life's stresses — and we use a medical approach to treat both.

A trend that should stay top-of-mind as we provide senior care

Startling statistics are surfacing as more and more physicians, families and senior care providers are realizing that post-retirement addiction is a potentially dangerous trend.

According to the National Council on Alcoholism and Drug Dependence Inc., 2.5 million older adults are living with an alcohol or drug problem. Regarding alcohol addiction, widowers aged 75 or more years have the highest rate of alcoholism in the United States, and almost 50% of residents living in skilled nursing facilities are fighting alcohol-related problems, with older adults requiring hospitalization for alcohol-related problems as often as for heart attacks.

What's truly startling is that almost 17 million prescriptions for tranquilizers are being prescribed for older adults each year. Benzodiazepines, a family of tranquilizing drugs commonly prescribed for anxiety, are the most frequently misused and abused prescription medications. 

Chronic health issues can complicate substance abuse and make intervention more difficult. Depending on the level of physical dependence, some addiction facilities won't take older adults due to the complexities involved in detox and treatment.

An additional factor in the meteoric rise in addiction rates for older adults is the aging of the baby boomer generation. A report from the Substance Abuse and Mental Health Services Administration shows that by the year 2020, the rate of addiction in the baby boomer generation is going to require roughly double the current availability of treatment services of today.

According to the same report, an estimated 4.3 million adults aged 50 or more years used an illicit drug in the past year, and among those aged 65 or older, nonmedical use of prescription drugs and alcohol abuse were the most common forms of substance abuse observed.

The next steps once an addiction has been diagnosed

If you think one of your residents might be suffering from an addiction, bring an addiction specialist into the equation. That person can help you determine whether the older adult needs to participate in a treatment program.

At any drug and alcohol treatment center, treatment for any addiction always should begin with a comprehensive medical and psychological drug and alcohol addiction assessment. These assessments include personality and neurocognitive testing, a psychiatric diagnostic evaluation, an addiction severity assessment and an addiction-related quality of life assessment — all designed to determine the most important areas of clinical concern for that individual person.

The resident's progress should be monitored regularly, and treatment should be coordinated by the entire medical, psychological and therapeutic team. Every drug and alcohol detox needs to be closely supervised by addiction-trained experts, with withdrawal symptoms and vital signs carefully monitored and managed.

In addition to detox and education, individuals undergo intensive one-on-one therapy, in-depth family and/or couples therapy as appropriate, trauma resolution, pain/anxiety management, neurological testing and treatment, cognitive behavior therapy and/or spiritual/faith-based classes. Appropriate family involvement and treatment are critical components of long-term alcohol and drug addiction rehabilitation.

Regardless of age, recovery is a life-long process, not a short-term cure, and should include education about the disease and the development of coping skills to handle life's challenges.

Scott Trout is executive vice president and chief operating officer of Enterhealth, a Dallas-based drug and alcohol addiction treatment company with both residential and outpatient services. The team at Enterhealth has noticed a steady increase in the number of older adults seeking help for addiction.

McKnight's Senior Living welcomes guest columns on subjects of value to the industry. Please see our submission guidelines for more information.

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