Elderly Populations, Treatment Issues

Risk Factors Unique to the Elderly

Individuals over the age of 65 disproportionately consume approximately 30% of all prescribed drugs and are the largest consumers of nonprescribed over-the-counter medications. They are three times as likely to use prescription drugs as younger individuals and spend more than $15 billion on these medications each year. This expenditure is fourfold greater per capita than that of younger generations. Furthermore, 22% of elders who receive Medicare use at least one prescription medication with addiction potential. For example, prescriptions are commonly written for opioid analgesics and for central nervous system depressants (e.g., benzodiazepines such as Valium or Ativan). In fact, approximately 40% of benzodiazepine prescriptions go to the elderly. And because these medications may rapidly produce psychological and physical dependence, they have great potential for problems. Such problems may then be complicated because the drugs may interact with the large number of other medications taken by elderly individuals. Over the course of one month, 60% to 70% of individuals 65 years of age or older take one or more medication combinations that put them at risk for experiencing an adverse drug reaction.

Another factor contributing to increasing risk is medication noncompliance or misuse. Substance misuse broadly refers to erratic use, underuse, or overuse, with the most common form being missed doses. Forgetting to take medication or intentionally skipping doses are sometimes to blame, complicated further when individuals try to compensate by doubling the amount at the next dosing. In fact, approximately 10% of elderly individuals report taking extra doses, and only about half of elderly individuals take their medications as prescribed. Even worse, medication compliance decreases as the number of prescribed medications increases.

Increased risk also develops from age-related changes in physiology (e.g., body composition and vital organ function changes). These can alter the [Page 355]metabolism, excretion, and distribution of drugs. For instance, drugs may become more potent and their effects less predictable with such physiological changes. For example, relative to youth, elders have higher blood alcohol levels after consuming similar amounts of alcohol.

Elder baby boomers may further be at increased risk for substance-related disorders because of social characteristics of their birth cohort. Increased exposure to recreational substance use and more tolerant attitudes toward use, compared to prior generations, are anticipated risks. The prevalence of illicit drug use among these individuals has consistently remained higher than age-matched samples from previous generations.

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