problem among elderly populations.

The disproportionately
greater exposure to medications by the elderly, coupled
with age-related physiological changes and problems
related to medication compliance, places this population at
great risk for adverse events. As life expectancy is
extended, there may be increased morbidity associated with
chronic diseases that may lead to increased use and abuse
of prescription and OTC medications.

There is a general trend for a decrease in substance abuse

over a person's life span, but increasing proportions of
younger substance abusers are surviving into late life.
These substance abusing survivors and individuals who
develop drug problems later in life will cause an increase in
the number of elderly drug abusers in our population.

Finally, it is important to recognize that there is great

heterogeneity among elderly individuals. We can expect
high interindividual variability in biologic, psychologic,
social and illness factors. The predictors and manifestations
of substance use disorders are likely to be variable in this
population. These may range from misuse of prescription
drugs to incorporation of psychoactive drugs into a lifestyle
characterized by addiction and its concomitant
psychological and cultural aspects. This suggests that the
management of this wide spectrum of problems will require
specific tailoring of treatments for groups of aging
individuals.

There continues to be a perception that substance abuse and

misuse in the elderly is not an important public health
problem for society. Most of the emphasis has been placed
on the study of younger populations without an
appreciation of the unique problems presented by the
elderly substance user. There is a need to develop a
treatment infrastructure that is sensitive to problems of
older substance users. This should include education of
professionals as well as that of the public at large.

References

Beers M, Avorn J, Soumerai SB et al. (1988), Psychoactive

medication use in intermediate-care facility residents.
JAMA 260(20):3016-3020.

Gordon SM, Kennedy BP, McPeake JD (1988),

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