ASNA Independent Study Activity - Substance Abuse and the Older Adult

Alabama Nurse,  Dec 2003-Feb 2004  by Varner, Joyce M

• E-mail
• Print
• Link

Objectives: At the conclusion of this activity the learner should be able to

1. Identify patterns of alcohol/substance abuse among the 50 and older population.

2. Assess for alcohol/substance abuse in older adults.

3. Develop a plan for identification and management of alcohol/substance abuse in older adults.

4. Be able to discuss why substance abuse in older adults is such a problem for the health care industry.

Directions: Read the article carefully. Copy the answer sheet printed at the end of the article (page 16) and fill out all sections completely. Mail to the address provided along with the appropriate fee. Certificates will be mailed upon successful completion of the post-test. Should you fail the test you will be notifies and provided an opportunity t retake the test. All retakes will require an additional fee.

Contact Hours and Accreditation: This activity for one (1) contact hour is provided by the Alabama State Nurses Association, which is an accredited provider of continuing education in nursing by the American Nurses Credentialing Center (ANCC) and the Alabama Board of Nursing.

Part 1 - First some facts regarding substance abuse in elders that may surprise you:

* Late onset alcohol problems are evident in many retirement communities, assisted living facilities, and nursing homes.

* Substance/alcohol abuse and psychoactive prescription drugs are at epidemic levels in women age 55 and older.

* 1.8 million older women are addicted to or abuse alcohol.

* 2.8 million older women abuse or are addicted to psychoactive prescription drugs.

* There is no difference between men and women on lifetime prevalence of cannabis, cocaine, amphetamines, opiates, or sedatives.

* Older women with substance abuse may not be recognized and referred in a timely fashion due to more rapid course, working at home on a part-time basis, or having a spouse who is also a substance abuser.

* Older adults have an enhanced vulnerability to drug and alcohol abuse that may result from 'empty nest* after children leave home, accepting the 'traumatic nest' associated with taking into the home adult children, unplanned and/or unwanted retirement, significant and/or sudden changes in physical, emotional, or intellectual functioning, or a major move to a new setting. Assuming care of relatives or grandchildren, coping with the death of a spouse, sibling, or friend, or adjusting to any new environment may trigger an increased desire to medicate feelings, conflicts, forced, choices and fears with a mood altering substance.

* Substance abuse among older Americans has become an epidemic that is invisible to most of the public, and family/caregivers tend to downplay abuse and instead relate symptoms to the aging process. Older adults consume 25-30% of all prescription drugs and 17% of acute care hospitalizations for adverse drug reactions.

* As substance abusers grow older, they tend to move socially from the center of the drug market to the margins of the drug industry where they cannot be seen and tend to hide out in loneliness and fear of victimization.

* Any use of alcohol in combination with some medications may be problematic or deadly in older adults.

* 20% of older men have alcohol problems but only 10-15% seeks treatment.

* Alcohol related problems represent a major but seldom-discussed public health problem, and the number of older people with alcohol problems will increase as this population ages.

* Alcohol is the #1 substance abused by older adults today but as the baby boomers age the health care industry will be dealing with a population that has abused various substances.

* Medication misuse is frequently unintentional among older adults.

* Chronic use of psychoactive drugs decreases cognitive functioning in aging adults.

* After drinking 1 oz of 80- proof alcohol, a 60 year old would have a 20% higher blood alcohol level than a 20 year old and a 90 year old would have a 50% higher blood alcohol level than a 20 year old.

Part 2 - The Problem Now

The increase in life expectancy achieved in the 20th century, along with increased affluence have produced a population of older adults who have not only dramatically increased in numbers, but also has more leisure time, more disposable income, a more positive attitude toward alcohol, and higher rates of alcohol and substance use than ever before in history. Since increased life expectancy is associated with greater exposure to health risks and increase in chronic disease and polypharmacy, an increased incidence of drinking problems, as well as disease/drug/alcohol, health care providers can anticipate interactions. Compounding this problem is the fact that society has two sets of older adults to consider: those older than 65 years and the baby boomers that are 50 to 65. Up to half of nursing home residents have a history of alcohol and/or drug abuse and 18% are current users. Alcohol-related hospital admission rates for older adults are nearly equal to admission rates for myocardial infarction. This is a frightening statistic! The issue of alcohol/drug abuse among older adults is fast becoming a growing concern for all health care providers, caregivers, the legal system, and substance abuse treatment centers.