Anda di halaman 1dari 2

9

Substance Abuse in Elderly


Individuals
DANIEL N. ALLEN AND RHONDA K. B. LANDIS

Introduction cause of methodological limitations. These meth-


odological limitations account, at least in part, for
Individuals over the age of 65 currently comprise the significant differences between studies examin-
12% of the U.S. population, and this figure is pro- ing rates of substance abuse among the elderly.
jected to reach 18% by the year 2020 and 20% by the Within the more general geriatric substance abuse
year 2030 (La Rue, 1992; Spencer, 1989). This literature, information on neuropsychological pro-
marked change in demographics reflects the aging files of long-term substance abusers is even more
of the baby boom generation. In the year 2010, the limited. One exception to this general paucity of
eldest of the 76 million baby boomers will start to information is within the area of alcohol abuse and
turn 65. So, while the current number of individuals dependence and, to a lesser extent, benzodiazepine
over the age of 65 is 30 million, by the year 2020, abuse and dependence. Of the existing literature,
this number will increase to 52 million. This general relatively more studies provide prevalence esti-
aging trend within our society, combined with the mates of elderly alcoholism, investigate neuropsy-
fact that substance abuse and, more specifically, chological sequelae of chronic alcoholism, and pro-
alcohol abuse is the single most prevalent psychi- vide recommendations for treatment of elderly
atric disorder among males suggests that manage- alcoholics. However, even in the cases of alcohol
ment of substance use disorders in elderly individ- and benzodiazepines, existing information is quite
uals will emerge as a critical area of health care limited.
delivery. In this chapter, we will summarize the avail-
However, within the more general substance able information on geriatric substance use dis-
use disorder literature, studies examining substance orders, with particular emphasis on the neuropsy-
use among elderly individuals are limited. There is chological concomitants of these disorders. The
only limited information regarding prevalence of majority of the discussion will focus on alcohol and
substance abuse and dependence in individuals over benzodiazepines, as these have been the most exten-
the age of 65. Some of the existing information sively studied and most frequently used. However,
probably significantly underestimates prevalence of we will also discuss some of the methodological
drug abuse and dependence among the elderly be- limitations of existing studies, including limitations
of current diagnostic criteria. In addition, we will
discuss prevalence rates of alcohol and drug use
disorders and several factors that increase elderly
DANIEL N. ALLEN • Psychology Service, Highland Drive
individuals' risk or potential for developing these
Veterans Affairs Medical Center, Pittsburgh, Pennsylvania
15206. RHONDA K. B. LANDIS • Behavioral Health disorders. Finally, we will make recommendations
Services, DuBois Regional Medical Center, DuBois, Pennsyl- for assessment and treatment of elderly individuals
vania 15801. with substance abuse disorder and dependence.

111
P. D. Nussbaum (ed.), Handbook of Neuropsychology and Aging
© Springer Science+Business Media New York 1997
ill CHAPTER 9

Definitions dependence, particularly as these definitions apply


to elderly individuals. We will discuss these limita-
There is currently no universally accepted defi- tions later in the chapter. Our discussion will focus
nition of substance use disorders. Because of this, primarily on substance abuse and dependence, with
clinicians and researchers define these disorders less emphasis on substance-related disorders result-
using a number of methods and criteria. The two ing from substance misuse and adverse side effects.
most popular systems that provide specific diagnos-
tic criteria are those promulgated by the Diagnostic
and Statistical Manual of Mental Disorders, fourth Potential for Abuse and Dependence
edition (DSM-N; American Psychiatric Associa- among Elderly Individuals
tion [APA], 1994) and the Research Diagnostic Cri-
teria (RDC; Spitzer, Endicott, & Robins, 1978). The Although individuals over the age of 65 make
DSM-N category of substance-related disorders is up only 12% of the U.S. popUlation, estimates sug-
broadly defined to include abuse of specific sub- gest that the elderly consume approximately 30% of
stances (e.g., alcohol, cannabis, opiates, etc.), medi- all prescribed drugs taken each year, making them
cation side effects, and exposure to toxins. In the the largest consumers of legal drugs in this country
DSM-IV nomenclature, substance-related disorders (Baum, Kennedy, & Forbes, 1984). Elders are also
are further broken down into two categories: (a) sub- the largest consumers of nonprescribed over-the-
stance use disorders, including substance abuse and counter (OTC) medications (Kofoed, 1984). When
substance dependence; and (b) substance-induced considering all types of OTC medication, estimates
disorders. The latter category includes disorders suggest that two thirds of all individuals over the
resulting from misuse of medications. age of 60 take at least one medication daily for
In contrast to diagnostic systems such as the treatment of arthritis, constipation, or insomnia
DSM-IV and RDC, there are also numerous self- (Abrams & Alexopoulos, 1988). Several studies
report measures used to diagnose alcohol use dis- have further investigated the drug use characteris-
orders such as the CAGE questionnaire (Ewing, tics of hospitalized and community dwelling el-
1984; Mayfield, McLeod, & Hall, 1974) and the derly. Ellor and Kurz (1982) conducted a drug sur-
Michigan Alcohol Screening Test (MAST; Selzer, vey of 41 patients (75% female) in a general and
1971). These self-report questionnaires are brief and rehabilitation hospital who were between 62 and 83
assess a range of alcohol symptomatology. They years of age. Overall, 134 drugs were prescribed
have defined cutoff scores demonstrated to accu- with an average of 3.1 drugs per person (range = 0-8
rately classify a significant proportion of alcoholics. drugs/person). For community dwelling elderly in-
Of the two instruments, we recommend use of the dividuals, prevalence rates of prescribed drug use
MAST for screening elderly individuals because it ranged between 2.1 and 4.5 medications per person,
detects more individuals who actually have diag- while use of OTC medication ranged between 2.3
noses of alcohol use disorders than does the CAGE and 3.4 drugs per person (Darnell, Murray, Martz,
(Fulop et aI., 1993). In many instances, these mea- & Weinberger, 1986; Pollow, Stoller, Forster, &
sures are used as screening devices to identify indi- Duniho, 1994). In these studies, the combined aver-
viduals who are at high risk for alcohol or drug age number of prescribed and OTC medications
abuse. After identification is made, further evalua- ranged between 4.4 and 7.9 per person (Darnell et
tion of symptomatology is conducted through clini- aI., 1986; Pollow et al., 1994). Outside of any other
calor standardized interviews before a final diag- considerations, the large number of medications
nosis is made. taken by elderly individuals increases the potential
In this chapter, we will discuss substance abuse for drug misuse, abuse, and dependence.
and dependence with the DSM-IV definition in Research also suggests that many elderly indi-
mind. However, we recognize that many definitions viduals do not take their medications as directed
have been developed to diagnose substance abuse (Darnell et aI., 1986; ElIor & Kurz, 1982). Ellor and
and dependence. We also recognize the limitations Kurz (1982) reported that individuals in their study
of any specific definition of substance abuse and missed doses of medications and none remembered

Anda mungkin juga menyukai