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Elderly Are Particularly Vulnerable to Both Misuse and Abuse of Prescription Drugs

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Elderly Are Particularly Vulnerable to Both Misuse and Abuse of Prescription Drugs

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This article was written by Noozhawk Contributing Writer Sonia Fernandez as part of Day 5 in Noozhawk's 12-day, six-week special investigative series. Related links are below.

The Noozhawk's Prescription for Abuse series is a special project exploring the misuse and abuse of prescription medications in Santa Barbara County. Our series is a result of an exciting and unique partnership with USC's Annenberg School for Communication & Journalism, which awarded Noozhawk a California Endowment Health Journalism Fellowship to undertake this important work.

Through our reporting and presentation, we will establish an independent baseline of where our community is with respect to the misuse and abuse of prescription medications; how the problem is affecting health care, education, law enforcement, criminal justice, addiction and treatment, and our culture and society; what we as a community can do to educate ourselves about prevention and controls; and how we can perhaps reverse what appears to be a very troubling trend.

Noozhawk staff writers Lara Cooper and Giana Magnoli are the lead reporters on the project, and they've been assisted by managing editor Michelle Nelson; reporters Alex Kacik and Sonia Fernandez; interns Kristin Crosier, Jessica Ferguson, Tim Fucci, Kristen Gowdy, Jessica Haro, Daniel Langhorne, Alexa Shapiro, Sam Skopp, Erin Stone and Sarah Webb; photographers Garrett Geyer and Nick St.Oegger; content producer Cliff Redding; and Web development staffers Will Macfadyen and Edgar Oliveira.

Ashley Almada, Garrett Geyer, Hailey Sestak and Billy Spencer of the Santa Barbara Teen News Network filmed more than two dozen public-service videos featuring many of our story sources.

The project is sponsored by the Santa Barbara Foundation in partnership with KEYT, sbTNN and Zona Seca. The Annenberg School is assisted by the Renaissance Journalism Center at San Francisco State University.


Day One:

» Quiet Epidemic of Prescription Drug Abuse Taking a Toll on Santa Barbara County

» After Losing It All, Former Drug Addict Looking Forward to Renewed Life

» USC, California Endowment Unite to Support Health Journalism at the Source

» Bill Macfadyen: Prescription for Abuse Project Is a Series of Opportunities

Day Two:

» Local, National Statistics Reveal Alarming Jumps in Misuse and Abuse of Medications

» Marijuana Use Trends Higher, Especially Among Young Adults, Sparking Public Health Concerns

» Alcohol Plays a Role All Its Own in Setting the Stage for Local Abuse, Overdoses

Day Three:

» Understanding Addiction Key to Dealing With Prescription Drug Abuse

» Donna Genera Has Seen the Price and Perils of Drug Addiction from All Sides

» Rich Detty Bears Burden of Not Knowing Extent of Dead Son's Drug Use

Day Four:

» Escalation of Drug Overdose Deaths Includes Increased Presence of Prescription Medications

» Santa Barbara Teen News Network Adds Another Dimension to Prescription Drug Abuse Series

» Dr. Chris Lambert Sounds Warning on Mixing Prescription Drugs with Alcohol

Day Five:

» Local Oversight of Prescription Medications Is Far More Focused Than State, Federal Controls

» Elderly Are Particularly Vulnerable to Both Misuse and Abuse of Prescription Drugs

» Second-Generation Pharmacist Peter Caldwell Fills a Vital Role with Patient Health Care

Day Six:

» Early Education for Parents and Youth Emerges as Critical Tactic to Thwart Drug Use

» Student Highs Can Lead to Tragic Woes with Addiction's Hook Just One Fateful Step Away

» From an Early Age, Shereen Khatapoush Saw the Horrors of Substance Abuse

» As a Parent Herself, Prosecutor Von Nguyen Brings Empathy to Job in Juvenile Justice

Day Seven:

» Law Enforcement Fights Battle Against Prescription Drug Abuse from Outside and Inside

» Sheriff Bill Brown a Strong Supporter of Re-Entry, Drug Abuse Treatment Efforts

» Speaking from Experience, Zona Seca's Kevin Smith Keeps Drug Abusers on Road to Recovery

Day Eight:

» Prescription Drug System Is Rife with Loopholes, Fraud and Lack of Oversight

» For Clinical Psychologist Neil Rocklin, Addiction Education Can't Begin Soon Enough

Day Nine:

» Drug Abuse Treatment Programs, Expertise Are Plentiful on South Coast

» Dr. David Agnew Sees Pain as Pathway to Abuse But Cautions Against Overreaction

Day Ten:

» Awareness, Disposal Key Elements to Reversing Tide of Prescription Drug Abuse

» Dr. Joe Blum Keeps Focus on His Veteran Patients Despite Health-Care System's Restraints

Day Eleven:

» Operation Medicine Cabinet Gets the Drop on Prescription Drug Disposal

» Lacey Johnson Gives UCSB Students an Education in Dealing with Drug Abuse and Addiction

Day Twelve:

» Santa Barbara County Officials Look for Solutions in Battle Against Prescription Drug Abuse

» Noozhawk Journalists Recount Lessons Learned from Prescription Drug Abuse Series

» Annenberg Fellowships Take a Diverse Approach to Community Health Journalism

» Dr. Nancy Leffert Champions Antioch University's Role in Fight Against Substance Abuse

» Professionals Working in Addiction Field Often Share Roots at Antioch University Santa Barbara

Seniors make up 13% of population, account for a third of all prescriptions written in the U.S.
Sunday, September 25, 2011

The baby boom culture. Longer, but not necessarily healthier lifestyles. A general lack of information and communication. Each of these elements plays a role in the growing phenomenon that is the misuse of prescription drugs by the elderly.

These behaviors include over- or under-use of prescription medications, use of the wrong medication, use for the wrong purpose, and in some cases, using contraindicated substances that may have a detrimental effect on the patient.

In many cases it comes down to a numbers game. According to the National Institute on Drug Abuse, older adults — age 60 years and up — comprise about 13 percent of the U.S. population, but account for a third of all prescriptions written in the United States. People are living longer with their age-related ailments and multiple specialists are prescribing numerous protocols.

“Anyone going to the specialist will get full treatments,” said Dr. Erno Daniel, a Sansum Clinic internist with a specialty in geriatric medicine.

The effects of two or three prescription regimens are predictable, Daniel said, but the more prescriptions piled onto the patient’s intake, the more difficult it is to anticipate the effects. Additionally, he said, the protocols used for elderly patients may be ones developed for patients 10 to 20 years younger, and likely don’t take into account the metabolic changes of the aging individual.

“There’s just not enough data,” said Daniel, referring to the optimal dosages and effects of multiple drug regimens in older individuals.

The aging brain also plays a huge role in the misuse of prescription drugs by older adults, Daniel said. By the age of 85, about 40 percent of older adults have some degree of cognitive impairment, leading to situations in which patients don’t remember to take their medications, or forget that they just did, or confuse one with another. Dementia and memory problems also make it difficult for physicians to tell when there is a problem with prescriptions when they interview an older patient.

Misuse through cognitive decline is a particular problem for Amy Mallett, who works with seniors at the Goleta Valley Community Center, 5679 Hollister Ave.

“It happens all the time,” she said.

Mallett said even slight changes in prescriptions — such as a different brand of the same drug — could confuse the center’s seniors enough to unintentionally misuse their prescriptions. Even different pills coming in the same colored bottles make it difficult to be sure they are taking enough of the right ones, she said.

“I would love for pills not to come in those bottles,” said Mallett, suggesting the use of color coding of some sort to aid users in keeping their medications straight.

Prolonged and constant use of certain medications, like painkillers and sedatives, can lead to dependency and drug-seeking behavior, doctors say. Sleep medications tend to be one of the more often abused drugs by the elderly, Daniel said.

“People in their 70s and 80s don’t really sleep soundly,” he added. “Some patients are really frustrated by that.”

Sometimes the frustration leads them to seek more and stronger prescriptions, Daniel said. The insidious thing is that the sleeping issue is a highly subjective one, with patients claiming they can’t sleep even as they spend much time under the haze of sedatives and tranquilizers. Patients will tend to supplement their prescriptions with over-the-counter drugs containing diphenhydramine, a popular allergy-relieving and sleep-inducing drug. While innocuous enough for younger patients, the drug can cause unintended effects — like urinary retention, for instance, setting off another string of symptoms and possibly more prescriptions.

Alcohol abuse, an often co-occuring disease, only serves to intensify the situation. Daniel said older Americans tend to be less likely to intentionally misuse drugs, but will self-medicate with alcohol.

“In older patients, alcohol has zero health protective benefits,” he said, a fact he stresses to older patients who still believe that drinking alcohol will contribute to their longevity.

Their sons and daughters, baby boomers having grown up in an era of the emergence of psychotropic drugs for prescription use and for pleasure, tend to have fewer reservations about narcotics.

And then there are the intricacies of the health-care system. Medicare patients who fall into the “hole” — a roughly three-month period during which they are financially responsible for their medicines, will often use less of their drugs in order to spend less of their fixed incomes on them.

“I see this all the time,” Daniel said.

Patients will either forego their prescriptions, electing instead to suffer, while substituting other medications — old and possibly expired ones, ones from their cohorts, or over-the-counter ones, he said.

Such was the case of one of Mallet’s seniors, a woman who, because she couldn’t afford her prescription, “borrowed” drugs from a friend that she thought were the same.

“She ended up OD-ing and dying,” Mallett said.

Daniel and Mallet both say that seniors who may have had a particularly bad financial time might even sell their prescriptions for the money.

Particularly vulnerable to all the missteps and abuses are those who live alone, they say. As people decline in old age and become more home-bound, watching out for prescription drug misuse — both intentional and unintentional — becomes a bigger task. Illness and depression only serve to isolate the patient more.

Noozhawk contributing writer Sonia Fernandez can be reached at Follow Noozhawk on Twitter: @noozhawk, @NoozhawkNews and @NoozhawkBiz. Connect with Noozhawk on Facebook.