Prescription drug misuse/abuse in the elderly

Department of Medicine, Section of Geriatrics, Michael E. DeBakey VA Medical Center, Baylor College of Medicine, Houston, TX, USA.
Geriatrics (Impact Factor: 1.35). 10/2008; 63(9):22-31.
Source: PubMed


One quarter of the prescription drugs sold in the United States are used by the elderly, often for problems such as chronic pain, insomnia, and anxiety. The prevalence of abuse may be as high as 11 percent with female gender, social isolation, depression, and history of substance abuse increasing risk. Screening instruments for prescription drug abuse have not been validated in the geriatric population. Benzodiazepines, opiate analgesics, and some skeletal muscle relaxants may result in physical dependence; however, tolerance, withdrawal syndrome, and dose escalation may be less common in the older patient. Lower doses may decrease the risk of abuse and dependence; however, fear of abuse often results in a failure to adequately treat symptoms such as anxiety, pain, and insomnia.

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    • "Consuming too much alcohol can lead to accelerated neurodegeneration (Cairney, Clough, Jaragba, & Maruff, 2007; Chan et al., 2010). Excessive alcohol consumption can also have negative interactions with medications commonly used by older adults and is a major risk factor for prescription drug misuse (Culberson & Ziska, 2008; McCabe, Cranford, & Boyd, 2006; Onder et al., 2002; Simoni-Wastila & Strickler, 2004). Older adults are actually hospitalized for alcohol-related complications as often as for myocardial infarctions and medication overdoses in older adults are commonly associated with alcohol (Dukes, Robinson, Thomson, & Robinson, 1992; Finkle, McCloskey, Kiplinger, & Bennett, 1976; Ødega˚rd & Rossow, 2004). "
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    ABSTRACT: Objectives: This study examines cognitive outcomes for alcohol drinking status over time, across cognitive ability and age groups. Methods: Data (1998-2005) from n = 571 Seattle Longitudinal Study participants aged 45+years (middle-aged: 45-64, young-old: 65-75, old-old: 75+) were analyzed to examine the alcohol drinking status effect (e.g., abstinent, moderate (less than seven drinks/week), at-risk (more than eight drinks/week)) on cognitive ability (e.g., memory, reasoning, spatial, verbal number, speed abilities). Results: Findings indicated that alcohol drinking status was associated with change in verbal ability, spatial ability, and perceptual speed. Decline in verbal ability was seen among alcohol abstainers and moderate alcohol consumers, but at-risk drinkers displayed relative stability. At-risk old-old adults and middle-aged adults (regardless of drinking status), displayed relative stability in spatial ability. Decline in spatial ability was however present among young-old adults across drinking status, and among abstaining and moderate drinking old-old adults. At-risk drinkers showed the most positive spatial ability trajectory. A gender effect in perceptual speed was detected, with women who abstained from drinking displaying the most decline in perceptual speed compared with women that regularly consumed alcohol, and men displaying decline in perceptual speed across drinking status. Discussion: In this study, consuming alcohol is indicative of cognitive stability. This conclusion should be considered cautiously, due to study bias created from survivor effects, analyzing two time points, health/medication change status, and overrepresentation of higher socioeconomic status and white populations in this study. Future research needs to design studies that can make concrete recommendations about the relationship between drinking status and cognition.
    Aging and Mental Health 08/2012; 17(1). DOI:10.1080/13607863.2012.717254 · 1.75 Impact Factor
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    • "Given that the medication classes noted above either have primary indications for the treatment of psychiatric symptoms (e.g., tranquilizers treat insomnia) or ameliorate symptoms as a secondary effect, the link between NUPM and psychopathology appears to warrant further study. Major depression (MDD) appears to be a particularly salient correlate of NUPM (Culberson and Ziska, 2008; Goodwin and Hasin, 2002; Wu et al., 2008a), as it is associated with substance use disorder (SUD) symptoms from NUPM in adolescents (Schepis and Krishnan-Sarin, 2008; Wu et al., 2008b), increased odds of NUPM-related SUD in adults (Huang et al., 2006) and a more severe profile of problematic nonmedical opioid use (Wu et al., 2011). Higher levels of depressive symptoms are linked to non-oral administration and more frequent stimulant nonmedical use (Teter et al., 2010). "
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    ABSTRACT: Nonmedical use of prescription medications (NUPM) has been associated with major depression (MDD), but the specific processes by which they might interact and influence one another are understudied. This investigation attempted to clarify the relationship between MDD and NUPM by examining whether age of MDD onset influenced current and past NUPM and by examining whether age of NUPM onset influenced lifetime or past year MDD. These goals were met through use of data from the 2005 to 2007 National Survey on Drug Use and Health. Analyses utilized design-based logistic regression, and current age and order of MDD onset and NUPM initiation were examined in interactions with age of MDD or NUPM onset. For each year MDD onset was delayed, odds of lifetime, past year, past 30-day NUPM and substance dependence from NUPM were decreased by 2.3%, 2.6%, 1.9% and 2.3%, respectively. Earlier NUPM onset increased odds of past year (3.8%) and lifetime MDD (4.3%) in young adults, and lifetime MDD (2.5%) in 26-34 age group. Current age also interacted with age of MDD onset, with effects on NUPM pronounced in the 65 and older cohort. Order of MDD/NUPM onset generally did not interact with age of MDD onset, but it did interact with age of NUPM onset; the effects of NUPM onset on past year MDD were only significant in those with NUPM first. These results highlight the need for further investigations of the interactions between depression and NUPM, particularly to evaluate potential causal relationships.
    Drug and alcohol dependence 07/2011; 120(1-3):99-104. DOI:10.1016/j.drugalcdep.2011.07.002 · 3.42 Impact Factor
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    • "In summary, screening, in combination with brief interventions, can help address some aspects of underidentification of and undertreatment for substance abuse among older adults (CSAT, 1999; Schonfeld et al., 2010). However, there are presently no validated drug abuse screening tools designed specifically for the elderly (Culberson & Ziska, 2008). Additional studies are needed to develop valid drug abuse screening instruments for older adults in various settings. "
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    ABSTRACT: Substance abuse among older adults is a looming public health concern. The number of Americans aged 50+ years with a substance use disorder is projected to double from 2.8 million in 2002-2006 to 5.7 million in 2020. The authors provide a review of epidemiological findings for this understudied area of research by focusing on illicit drug use disorders and nonmedical use of prescription drugs among adults aged 50+ years. MEDLINE and PsychInfo were searched using keywords drug use, drug abuse, drug misuse, substance use disorder, and prescription drug abuse. Using the related-articles link, additional articles were screened for inclusion. This review included articles published between 1990 and 2010. Result: Rates of treatment admissions involving primary use of illicit and misuse of prescription drugs have increased, while rates involving primary use of alcohol only have decreased. Alcohol, opioids/heroin, and cocaine were more likely than other substances to be associated with treatment use. Limited research data suggested the effectiveness of treatments, especially for women. Furthermore, older adults appeared to be less likely than younger adults to perceive substance use as problematic or to use treatment services. There is robust evidence showing that an increased number of older adults will need substance abuse care in the coming decades. Increasing demands on the substance abuse treatment system will require expansion of treatment facilities and development of effective service programs to address emerging needs of the aging drug-using population.
    Journal of Aging and Health 11/2010; 23(3):481-504. DOI:10.1177/0898264310386224 · 1.56 Impact Factor
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