[Noozhawk’s note: This article is part of Day 5 in Noozhawk’s 12-day, six-week special investigative series, Prescription for Abuse. Related links are below.]
The baby boom culture. Longer, but not necessarily healthier lifestyles. A general lack of information and communication. Each of these elements plays a role in the growing phenomenon that is the misuse of prescription drugs by the elderly.
These behaviors include over- or under-use of prescription medications, use of the wrong medication, use for the wrong purpose, and in some cases, using contraindicated substances that may have a detrimental effect on the patient.
In many cases it comes down to a numbers game. According to the National Institute on Drug Abuse, older adults — age 60 years and up — comprise about 13 percent of the U.S. population, but account for a third of all prescriptions written in the United States. People are living longer with their age-related ailments and multiple specialists are prescribing numerous protocols.
The effects of two or three prescription regimens are predictable, Daniel said, but the more prescriptions piled onto the patient’s intake, the more difficult it is to anticipate the effects. Additionally, he said, the protocols used for elderly patients may be ones developed for patients 10 to 20 years younger, and likely don’t take into account the metabolic changes of the aging individual.
“There’s just not enough data,” said Daniel, referring to the optimal dosages and effects of multiple drug regimens in older individuals.
The aging brain also plays a huge role in the misuse of prescription drugs by older adults, Daniel said. By the age of 85, about 40 percent of older adults have some degree of cognitive impairment, leading to situations in which patients don’t remember to take their medications, or forget that they just did, or confuse one with another. Dementia and memory problems also make it difficult for physicians to tell when there is a problem with prescriptions when they interview an older patient.
Misuse through cognitive decline is a particular problem for Amy Mallett, who works with seniors at the Goleta Valley Community Center, 5679 Hollister Ave.
“It happens all the time,” she said.
Mallett said even slight changes in prescriptions — such as a different brand of the same drug — could confuse the center’s seniors enough to unintentionally misuse their prescriptions. Even different pills coming in the same colored bottles make it difficult to be sure they are taking enough of the right ones, she said.
“I would love for pills not to come in those bottles,” said Mallett, suggesting the use of color coding of some sort to aid users in keeping their medications straight.
Prolonged and constant use of certain medications, like painkillers and sedatives, can lead to dependency and drug-seeking behavior, doctors say. Sleep medications tend to be one of the more often abused drugs by the elderly, Daniel said.
“People in their 70s and 80s don’t really sleep soundly,” he added. “Some patients are really frustrated by that.”
Sometimes the frustration leads them to seek more and stronger prescriptions, Daniel said. The insidious thing is that the sleeping issue is a highly subjective one, with patients claiming they can’t sleep even as they spend much time under the haze of sedatives and tranquilizers. Patients will tend to supplement their prescriptions with over-the-counter drugs containing diphenhydramine, a popular allergy-relieving and sleep-inducing drug. While innocuous enough for younger patients, the drug can cause unintended effects — like urinary retention, for instance, setting off another string of symptoms and possibly more prescriptions.
Alcohol abuse, an often co-occuring disease, only serves to intensify the situation. Daniel said older Americans tend to be less likely to intentionally misuse drugs, but will self-medicate with alcohol.
“In older patients, alcohol has zero health protective benefits,” he said, a fact he stresses to older patients who still believe that drinking alcohol will contribute to their longevity.
Their sons and daughters, baby boomers having grown up in an era of the emergence of psychotropic drugs for prescription use and for pleasure, tend to have fewer reservations about narcotics.
And then there are the intricacies of the health-care system. Medicare patients who fall into the “hole” — a roughly three-month period during which they are financially responsible for their medicines, will often use less of their drugs in order to spend less of their fixed incomes on them.
“I see this all the time,” Daniel said.
Patients will either forego their prescriptions, electing instead to suffer, while substituting other medications — old and possibly expired ones, ones from their cohorts, or over-the-counter ones, he said.
Such was the case of one of Mallet’s seniors, a woman who, because she couldn’t afford her prescription, “borrowed” drugs from a friend that she thought were the same.
“She ended up OD-ing and dying,” Mallett said.
Daniel and Mallet both say that seniors who may have had a particularly bad financial time might even sell their prescriptions for the money.
Particularly vulnerable to all the missteps and abuses are those who live alone, they say. As people decline in old age and become more home-bound, watching out for prescription drug misuse — both intentional and unintentional — becomes a bigger task. Illness and depression only serve to isolate the patient more.