Preventing Drug Misuse in Seniors 

Author: Audrey Ignatoff, M.S. Preventing drug misuse in seniors is of critical concern to health care professionals, caregivers, and seniors themselves. In order for any prevention program to be effective, it must be a team effort involving both an art and a system. Seniors comprise about 12 percent of the total U.S. population, yet consume from 25 to 33 percent of all prescription drugs.  They also take over-the-counter drugs and home remedies in great quantities. Medications certainly play an important part in patient care, but the improper use of drugs may cause a variety of serious problems including drug misuse and abuse.  Drug misuse is the use of medications that result in social, psychological, and/or physical harm. Examples of drug misuse may vary from not taking necessary medications to becoming dependent upon psychoactive drugs. Problems with medications can develop from excessive use, under use, or the inappropriate mixing of drugs with other presceiptions, over-the-counter preparations, alcohol, and even certain foods. The cost of drug misuse and abuse among the elderly is staggering! According to a 1995 article in USA Today entitled, "Prescription Misuse Costs Nation Billions," prescription drug related problems cost an estimated $75.6 billion and cause 119,000 deaths yearly. An analysis of the reasons for these costs indicates the following: Decreased comfort and life span Increased risk of dependency and addiction Increased emergency room visits Increased and longer hospital stays Increased admission to long-term care facilities Higher medical and hospital costs Higher drug costs Increased risk of misdiagnosing patient as "senile." Increased accidental deaths and suicides As health care professionals, we must be aware of the components of this complex problem, such as it's nature, scope and patterns. It is also important to understand the problems of adverse drug reactions, how the physiology of aging effects drug metabolism, problems of patients compliance, and the role of the health care professional in preventing drug misuse. For example, it is important to be aware that about 85 percent of those over 65 do take prescription drugs, over-the-counter drugs, and home remedies on a regular basis. People over 65 take an average of 11 different prescription drugs per year. The incidence of adverse drug reactions in geriatric patients is from 2-3 times higher than for younger adults. Many of these drug reactions are caused by drug-drug interactions or food-drug interactions. Also, the slowing down of bodily functions such as metabolism, blood flow and excretion can cause unpleasant or dangerous effects. The risk of adverse drug reactions increases with age with cardiovascular and psychoactive drugs being responsible for most incidents. Drug toxicity may cause symptoms such as confusion, dizziness, falling and incontinence and often mimics other symptoms of aging such as weakness, fatigue, absentmindedness, anorexia, and even Chronic Brain Syndrome. An elderly person with these toxic side effects can have a serious injury or be misdiagnosed as "Senile." This too often results in unnecessary or avoidable placement in a long-term care facility. Clearly, we must try to find solutions to this pervasive and insidious problem among our Seniors if they are going to enjoy the quality of life that they deserve. Therefore, designing effective and systematic educational strategies for professionals is critical. The strategies may vary according to the needs of the staff and patients at a particular site. Developing a results-oriented program involves an evolving process as does any other art form. However, it is not enough for health care professionals to understand the problem of drug misuse in the elderly. It is also critical that they communicate effectively not only with other professionals, but caregivers and seniors as well. Otherwise, the system is broken and the art of prevention cannot occur. This leaves us to the important task of designing a comprehensive program that can reach all relevant members on this team: the health care professionals, the caregivers, and the patients. It is important to identify all available experts and materials in this field that can be of assistance to your program. Below are some of the ways to address this problem. I'm sure that you can think of others. In-services for nurses, nursing assistants, social workers and others Seminars for professionals Health Fairs for Seniors Programs for clinic patients Programs for discharge patients Programs for community groups Audrey Ignatoff, M.S.   About Senior Arts and Systems: Senior Arts and Systems provides materials on preventing drug misuse in seniors. Their manual entitled, The Art and Systems of Medication Use for Seniors: A Training and Resource Manual will assist you in developing programs by providing information and by identifying other valuable resources that are available. You may reach Senior Arts and Systems at seniorarts@aol.com. You may visit their web site at http://members.aol.com/seniorarts/ for more information and to order the training manual. Audrey Ignatoff, a geriatric consultant, heads Senior Arts and Systems. She has over twenty years of experience in this field and is the former Coordinator of the New York State Subcommittee on Drug Misuse in the Elderly. In this capacity, she developed a statewide educational program for professionals and seniors. She conducts in-services and seminars in the New York Metropolitan Area. Ms. Ignatoff believes that "prevention is an art and a system."