The aging process can be a difficult transition time. No one wants to get older, and aging brings a new set of variables to the table. Bodies change and start to decline, and it gets harder to remember small details. Pain management can be difficult, and socializing and social opportunities change.
The Department of Health and Human Services defines being elderly as those over age 65, while other resources move the age down to 60. According to their Administration on Aging, and the most current statistics in the United States, 12.9 percent of the population falls into this category. By the year 2030, those numbers are expected to rise closer to 19 percent. Currently, this accounts for one in eight people.
The elephant in the room among America’s elderly population seems to be the rise of substance abuse. The NCBI calls this one of the fastest growing health problems in the country, affecting 17 percent of adults over age 60. Elderly patients typically take a lot of medications for various ailments with more benzos, or benzodiazepines, being prescribed to them than any other age group. The NCBI estimates that between 17 and 23 percent of the American adult population over age 60 is prescribed a benzo.
Epidemic of Elderly Substance Abuse
There are many factors at work that influence why older adults may turn to abusing prescription and non-prescription substances. Most commonly abused substances seem to be over-the-counter substances like alcohol, with anywhere between two and 20 percent of the elderly population abusing alcohol, according to Psych Health, and the abuse of prescription drugs like benzos.
Elderly people use prescription drugs as much as three times more than the average person. This sheer volume alone makes it come as no surprise that these drugs are so heavily abused. Psych Health Roanoke reports that 83 percent of adults over age 65 take a prescription drug with 30 percent taking eight or more prescriptions daily. Statistically, this puts this population group at great risk for prescription drug abuse, and with so many of these prescriptions including a benzo, it should come as no shock that so many elderly people are abusing them.
- Muscle spasms
- Alcohol dependency
Benzodiazepines work as a minor tranquilizer or sedative, and they are very common for the short-term use of helping with insomnia or mild anxiety and depression. They are sometimes prescribed before a surgical procedure as well. The key phrase here is “short-term.” Benzodiazepines are not intended to be used chronically as they can lead to tolerance, dependence and addiction, as well as the fact that they don’t actually solve any of the problems causing the symptoms, but merely act to control them briefly.
The most common path to abusing benzos is through a prescription. Prescription drug abuse is defined as using the drug outside of the means of the prescription, meaning in excess, when it is no longer medically necessary or after the prescription has expired. Most users, especially in the elderly population, likely have a valid prescription for a benzodiazepine. Those who abuse benzos can find ways to obtain the drug through legal means, beyond the medical necessity. Benzodiazepines come in many forms, most often known by these popular names:
There are many, many other types and brands of benzodiazepines as well, although American Family Physician lists these four as the most commonly prescribed.
Benzodiazepines are known for their immediate effect and are commonly prescribed for as-needed use. Elderly patients are at a high risk for being overprescribed these types of medication, and sometimes are even prescribed variant versions of benzodiazepines from multiple doctors from different subspecialties simultaneously.
The elderly often suffer from a type of negative stereotype referred to as “ageism,” in which younger generations tend to ascribe problems of older adults to their advancing age and not seek to understand the underlying issue. This stereotype can cause the elderly to internalize their problems and not seek care as easily as when they were younger. It can also be evident in their health care. Primary care doctors are likely to be less attentive, ascribe symptoms to simply “getting old,” and hurry patients through exams, prescribing quick-fix medications instead of looking deeper.
Dangers of Benzo Abuse for the Elderly
As mentioned earlier, benzodiazepines work as a band-aid or patch for an underlying issue and not as a solution. Insomnia and anxiety are common among the elderly population. While a benzo may help the symptoms at the time, they will not root out the underlying cause. This can lead to patients developing a tolerance to the drug and subsequently overmedicating by taking more over time to achieve the same results. Taken as intended, benzos can be safe and effective. The biggest danger with taking a benzodiazepine is becoming addicted, but some of the other side effects include:
- Increased depression
- Motor impairment
- Slurred speech
- Vision issues
- Impaired memory functions
In addition, the British Medical Journal reported that elderly users of benzodiazepines have a 50 percent higher chance of developing dementia in the following 15 years as compared to those who never took the drug. Health care professionals disagree on whether or not the use of benzos can lead to increased falls and hip fractures as well. While cognition and motor skills are likely to be impaired and increase the chance for injury, it is unclear if benzos are at fault for the severely debilitating and sometimes life-threatening hip fractures in persons over age 65.
Dangers of abusing substances like benzos are magnified in the elderly population due to physiological changes in the body as well as age-related changes, like drug metabolism and its interaction with other drugs and prescriptions the patient may be taking. Since elderly patients regularly take more than one medication at a time, mixing a benzo with other drugs can have many adverse and dangerous effects. Benzodiazepines are also commonly mixed with alcohol, which is also highly dangerous and can lead to severe memory impairment among other things.
How Abuse Is Overlooked and Under Diagnosed
Elderly substance abuse is a unique social concern with special circumstances. While the perception may be that much of this section of the population is under constant and supervised care, the opposite is actually true as SAMHSA states that only 4.6 percent of adults over age 65 are in nursing homes or receiving around-the-clock, in-home nursing care. That leaves a large percentage of elderly people living independently.
As retirement sets in, the elderly tend to interact with fewer people on a daily basis, increasing their risk for going long periods of time without being diagnosed with a substance abuse disorder. They are less likely to get in trouble with the law, get in traffic accidents, or have problems in the workforce, which are typical symptoms for substance abusers. They are likely to view their use of medications and substances as a private matter, and their subsequent pulling out of the public eye and mainstream society can amplify this.
There is also a distinct of a lack of awareness of substance abuse even being an issue for the elderly. Family members and loved ones may also sense problems but choose to ignore them. There is a pervasive feeling among the population that the elderly are entitled to their quality of life, and many turn a blind eye to their abuse of substances like benzodiazepines. Another reason is the shame involved. Those who suffer from substance abuse as well as those around them can view the abuse as an embarrassment and hide its symptoms.
As aforementioned, health care visits are increasingly shorter, and professionals may tend to overlook symptoms of substance abuse in the elderly population. This is in part due to these symptoms sometimes mimicking those of other medical disorders the patient may be suffering from, such as depression, diabetes and dementia. They may also hesitate to delve deeper into discovering the pattern of abuse due to ageism even when symptoms are clear. Drug trials tend to overlook this part of the population as does medical research. As stated earlier, elderly patients also see many different health care professionals, and each may not be aware of what the others are prescribing.
One of the most important things to remember is that the elderly deserve as much care and attention as the rest of society, and their specific needs make their treatment highly specialized. Identifying a substance use disorder can be difficult at any age. Benzo abusers can display drug-seeking behaviors and may shop for different doctors to find one who will give them the drug they seek. Tolerance occurs in chronic users, and those abusing benzos will likely take higher and higher doses. Personality shifts can occur; however, this is harder to diagnose in the elderly population due to other diseases, such as Alzheimer’s and dementia, coupled with the memory impairment that can occur with age.
The first thing to do to help prevent substance abuse in an elderly adult is to make sure all doctors and health care professionals are on the same page and sharing records and prescription recommendations. Knowing a person’s history and tendency toward addiction is also helpful. Getting help for the underlying issues is key to reversing an addiction to benzodiazepine.
Michael’s House helps to stabilize elderly patients in a safe and secure environment surrounded by professionals and with the help of consulting physicians. Our specialized staff works to treat the whole person, including both emotional and physical support in our offerings. We believe everyone deserves benzodiazepine addiction treatment, no matter their age. Call now to speak with our admissions coordinators and learn more about our individualized and specialized care.