Over 65

Substance abuse occurs in older people, but less frequently than in younger people.

Benzodiazepines are the most common drugs of dependence in the elderly. Dependence is usually the result of long-term prescription, rather than illicit use. Major adverse effects include daytime sedation, unsteadiness, mood disturbance and cognitive impairment. Cognitive impairment may present as memory difficulties and continual use may result in a dementia like syndrome. Benzodiazepine use increases the risk of falls and hip fracture. Driving skills may be impaired. Memory and other cognitive functions improve after discontinuation of long term benzodiazepine treatment. Elderly people are less likely to withdraw from benzodiazepines and are more likely to relapse after withdrawal than younger people.

Abuse of prescribed opiates by elderly people is uncommon unless the person was an opioid abuser when younger. Elderly people who become dependent on prescribed opioids tend to have significant psychiatric problems.

Although use of illicit drugs is uncommon in elderly people, use of over the counter preparations is common and can result in medical and psychological problems. For example, chronic aspirin ingestion can result in a dementia like syndrome with tinnitus and irritability.

There is clearly a rise in the number of drug mis-users maintained over a long period of time on substitute medications e.g. Methadone. It is not unusual for clinicians these days to be caring for an older drug using population including patients in their 60’s or older.

Older drug mis-users may also have special health needs. Overdose death incidence can be represented as a U-shaped curve, most common in the young and older age groups. There are many reasons why increasing age may affect the individual vulnerability to the effects of drugs (prescribed or non-prescribed) and alcohol.

Health problems resulting from prolonged drug use (including tobacco and cannabis) and alcohol can exacerbate the decline in health that older adults already experience. Loneliness, loss of loved ones, or a declining sense of purpose can also lead older adults to return to drugs they used casually as younger people or to alcohol.

Advanced age, frailty and an increased need for prescription medications are all factors that contribute to the patient’s risks of developing a drug related problem.

Amended June 2008