Pain of aging Making Prevention Work for Older Adults Program made possible through collaboration of...

Pain of agingMaking 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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04/19/23 2Cornerston Wellness, Inc. www.cornerstonenews.com

Fact versus fiction

Separating the truth from misconceptionUnderstanding older adults and issues with :medication use, misuse and abuseunique vulnerability to medication, alcohol, and other drug use problemsOver-the-counter and herbal remedies

Opiate use in Ohio 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

04/19/23 Cornerston Wellness, Inc. www.cornerstonenews.com

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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=75.7/80.8Source: 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?

Mick Jagger-69 Bruce Springsteen-63 Paul McCartney-70 Judy Collins-73 Meryl Streep-63 Bruce Jenner-62 Stephen King-65 Sophia Loren-7804/19/23 12Cornerston Wellness, Inc.

www.cornerstonenews.com

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? 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 painSource: 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


Older adults consume more prescribed and over the counter drugs than any other age group. TRUE.

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


Opiates and elderly 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 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 haveharmful interactions with alcohol and other prescribed medicines, especially narcotics and bebenzodiazapines. True

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


The normal process of aging increases older adultsvulnerability to the development of a problem with alcohol andto 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


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!!!


Alcohol and medication misuse is easy to identifyin 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


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


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


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


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


A person’s primary care physician would be able to tella person if he or she had a problem with alcohol and /or medication. FALSE.

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


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


Even if you think someone you care about has a problemwith alcohol or misuse of medicine, you should never say anything about it to him or her. FALSE.

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.

THE MORE MEDICATIONS A PERSON TAKES THE GREATE THE RISK OF MISUSE, WHETHER INTENTIONAL OR ACCIDENTAL

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.


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


“Any symptom in an elderly patient should be considered a drug side effect until proved otherwise.”

J. Gurwitz et al.; Brown University, 1995


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


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


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


Contact us

Cindy McQuown, Cornerstone Wellness Center, Co-Director, [email protected]


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