Monthly Archives: November 2016

Plan a Healthy Lunch on Nov. 15

Plan a Healthy Lunch on Nov. 15

During a busy week, it can be difficult to make smart and healthy lunch choices. That’s why the American Diabetes Association® launched National Healthy Lunch Day, which raises awareness about the importance of good nutrition. Download our resources and encourage your friends, family and coworkers to eat right with every bite on Nov.15.

Let’s do lunch—a healthy lunch!
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November Is American Diabetes Month®

November Is American Diabetes Month®

No one tells the story of diabetes better than you—the people who live with it every day. That’s why we want you to show the world what diabetes is really like. We hope you’ll join our American Diabetes Month campaign, sponsored by Colgate Total® and Medtronic Diabetes®, by sharing your challenges and triumphs on social media using #ThisIsDiabetes.

Share your story and spread the word.

Alcohol Consumption in Seniors: A Delicate Balance

Alcohol Consumption in Seniors: A Delicate Balance

Numerous studies on the effects of alcohol consumption in seniors indicate that moderate drinking by seniors can have a positive impact on general health. However, there is also a concern that heavy drinking can have adverse effects, and that alcohol abuse is often missed in the senior population. The guidelines for alcohol consumption in seniors are not the same as for the younger population and are impacted by several factors, such as physical changes caused by age, medications, and chronic conditions.

In general, for healthy senior adults moderate drinking is considered to be one-half to one ounce of pure alcohol per day (for men up to two ounces), which in the U.S. equates to one 12-ounce beer, 8 ounces of malt liquor, 5 ounces of wine, or 1.5 ounces of distilled spirits. These amounts may be lower for women and may decrease the older a person gets due to age-related physical changes that significantly affect the way an older person metabolizes alcohol. Compared to complete abstinence, this moderate intake has shown to increase bone density in women, protect against cognitive decline and dementias, and protect the vascular system. There are also lower morbidity rates in moderate drinkers as compared to abstainers and heavy drinkers.

For seniors who are dealing with illnesses or chronic conditions, or who may be taking medications, even over-the-counter medications, however, any amount of alcohol could, cause serious health issues or death. Considering these factors, it is important for seniors to be aware of their alcohol consumption, and for them and those around them to be able to identify when alcohol consumption has crossed into alcohol abuse.

Identifying Alcohol Abuse

The rate of alcoholism in the elderly is greatly underestimated for several reasons. The symptoms, for starters, are different in seniors than in younger people. For example, the American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) criteria for alcoholism includes “Failure to fulfill major role obligations at work, school, or home.” Criteria such as this may not apply to retired seniors who may have no or little role obligations.

Typical warning signs, such as fatigue, irritability, insomnia, chronic pain, or impotence can also be attributed to any number of physical maladies common in seniors. Hospital personnel may miss identification of alcohol problems in seniors due to a number of factors, such as being focused only on the senior’s current medical complaint, taking less accurate histories on alcohol use (as compared to younger patients), or being uncomfortable with questioning or trying to change a senior’s established habits.

Often, the senior’s family hesitate to address the senior’s drinking, believing that the person should be left alone to enjoy the final years of his or her life. Unfortunately, the negative consequences and effects on the senior’s quality of life warrant intervention. The rate at which alcohol problems are missed within the health services setting means that identifying alcohol problems in seniors relies heavily on family members, friends, caregivers, and other members of the senior’s community. The following guidelines can help these individuals identify potential alcohol abuse.

Identify at-risk individuals

Family, friends, and caregivers should be particularly mindful of seniors who have suffered significant losses, such as the loss of a spouse or friends, loss of income or social network due to retirement, or loss of mobility and health. Seniors who have a past history of substance abuse are also high-risk candidates for late-onset alcoholism. Depression and other mood and psychiatric disorders can additionally contribute to a senior’s risk of dependence on alcohol.

Note physical changes

Physical symptoms of alcohol abuse include the following:

  • sleep difficulties/changes
  • cognitive impairment
  • slurred speech
  • incontinence
  • poor hygiene
  • difficulty concentrating
  • restlessness and agitation
  • frequent falls and unexplained bruising
  • changes in eating habits
  • unexplained chronic pain complaints
  • unexplained stomach upset, vomiting or nausea
  • blurred vision and dry mouth

Note emotional or social changes

Seniors who are abusing alcohol may become increasingly isolated; lose interest in friends, family, and activities that they previously enjoyed; or be irritable, depressed, or sad. Family, friends and caregivers may also notice the senior is drinking while taking prescription drugs and against the advice of doctors. They may notice a large number of empty beer or wine bottles in the trash, or that the senior is drinking with every meal or secretively drinking.

Addressing Alcohol Abuse

Family, friends, caregivers, and other community members who suspect a senior may have a problem with alcohol should talk with a professional who is experienced working with older adults, such as a doctor, counselor, social worker, or the senior’s pastor or minister. These professionals can offer guidance on how to address their concerns with the senior. There are also many organizations, such as Alcoholics Anonymous, that can provide assistance on specific strategies for speaking with the senior regarding his or her alcohol use.

How In-Home Care Can Help

Families who live far from their senior loved ones may want to consider having a caregiver visit with and aid the senior. Caregivers can provide companionship and interaction, which can relieve symptoms of depression, and be a valuable resource, letting the family know if there are changes in the senior’s behavior or physical characteristics. They can also help remind the senior when medications are due and read prescription labels to help seniors avoid alcohol interactions. For more information on how in-home care can help, visit ComfortKeepers.com.

Resources for Seniors, Family, and Caregivers

The Substance Abuse and Mental Health Services Administration (SAMHSA) has a number of free guides and brochures for download:

The National Institute on Aging has a free downloadable guide, Older Adults and Alcohol (http://www.nia.nih.gov/health/publication/older-adults-and-alcohol), as well as an Alcohol Use In Older People website (http://www.nia.nih.gov/health/publication/alcohol-use-older-people).

 

References

Centers for Disease Control and Prevention. (2013). Alcohol and public health: Frequently asked questions. Retrieved from http://www.cdc.gov/alcohol/faqs.htm#standDrink.

Ganry, O., Baudoin, C. & Fardellone, P. (2000). Effect of Alcohol Intake on Bone Mineral Density in Elderly Women: The EPIDOS Study. American Journal of Epidemiology, 151(8), 773-780.

Gronbaek, M., Deis, A. Becker, U., Ole Hein, H., Schnohr, P., Jensen, G., et al. (1998). Alcohol and mortality: Is there a U-shaped relation in elderly people? Age and Ageing, 27, 739-744.

Kim, J.W., Lee, D.Y., Lee, B.C., Jung, M.H., Kim, H., Sung, Y, et al. (2012). Alcohol and Cognition in the Elderly: A Review. Psychiatry Investig., 9(1), 8-16. English. Retrieved from http://dx.doi.org/10.4306/pi.2012.9.1.8.

U.S. Department of Health and Human Services. (2000). Substance abuse among older adults: A guide for social service providers. (DHHS Publication No. (SMS) 00-3393). Rockville, MD: Levin, S.M. & Kruger, J.D. (Eds.).

Mcinnes, E. & Powell, J. (1994). Drug and alcohol referrals: Are elderly substance abuse diagnoses and referrals being missed? BMJ, 308, 444. Retrieved from http://dx.doi.org/10.1136/bmj.308.6926.444

O’Connell, H., Chin, A., Cunningham, C. & Lawlor, B. (2003). Alcohol use disorders in elderly people—redefining an age old problem in old age. BMJ, 327, 664-667.

Peters, R., Peters, J., Warner, J., Beckett, N. & Bulpitt, C. (2008). Alcohol, dementia and cognitive decline in the elderly: A systematic review. Age and Ageing, 37, 505-512.

Rapuri, P.B., Gallagher, J.C., Balhorn, K.E. & Ryschon, K.L. (2000). Alcohol intake and bone metabolism in elderly women. Am J Clin Nutr, 72, 1206-1213.

Wadd, S. & Forrester, D. (July 2011). Alcohol problems in old age. Generations Review.  Retrieved from http://www.britishgerontology.org/DB/gr-editions-2/generations-review/alcohol-problems-in-old-age.html.

– See more at: http://www.comfortkeepers.com/home/info-center/senior-health-wellbeing/alcohol-consumption-in-seniors-a-delicate-balance#sthash.6ojmgsLD.dpuf

Guide to Addiction Prevention for Seniors

Guide to Addiction Prevention for Seniors

When discussing substance abuse and addiction, most people think about teenagers and young adults. Much public education is devoted to addiction prevention beginning in the elementary years, as evidence has shown that early education and intervention reduces the likelihood that children will experiment with drugs. Most people would be surprised to learn that substance abuse and addiction is actually a growing problem among senior citizens.

This guide contains more than 50 valuable resources from high-quality sources such as government and education sites, leading professional journals, organizations devoted to substance abuse and addiction awareness and treatment, and other informative and reputable sources.

Table of Contents:

Lack of Adequate Training for Substance Abuse and Addiction in Seniors

Because of this widespread misconception, most caregivers and family members of the elderly don’t even consider substance abuse as a possibility. But it’s actually a problem that’s likely to become even more prevalent in the coming years. According to a report from the Institute of Medicine, however, “Current education and training for most health care providers do not cover the skills and competencies necessary to provide adequate care for older adults who need MH/SU care.” In other words, we’re unprepared.

Richard A. Friedman, M.D., explains in an article for The New Old Age Blog that this trend shouldn’t be surprising when considered in the broader context of our aging society. The Baby Boomers, currently entering their senior years, grew up in the ‘60s and ‘70s, making them far more likely to have experimented with illicit drugs than the generations before them.

Here are 7 excellent resources on substance abuse in seniors, identification and treatment:

Substance Abuse and Addiction are Already Common in the Elderly

Substance abuse and mental health disorders aren’t exactly uncommon among the elderly population as it is. Data from 2010 suggests that between 14 and 20 percent of the elderly population have one or more substance abuse or mental health disorders, which equates to approximately 6 to 8 million older Americans.

In 2010, there were 40 million Americans age 65 and older, a number which is expected to increase to 73 million by 2030. Additionally, Friedman points out that the rates of illicit drug use among adults aged 50 to 59 increased from 2.7 percent to 6.3 percent between 2002 and 2011, according to research from the Substance Abuse and Mental Health Services Administration.

Check out these 7 resources for more statistics and research on drug abuse and addiction in the elderly:

Substance Abuse is Often Overlooked in the Senior Population

Substance abuse and addiction exist in the elderly population, but it’s not something family members, caregivers, physicians and other people typically think about. If they do think about it, they may not be comfortable asking about it.

In older adults, even moderate substance abuse can be dangerous. Older people often metabolize foods and substances at different rates, making it easier to accumulate dangerously high concentrations of drugs and alcohol. The brain may handle substances differently in older age than it did in a person’s 20’s or 30’s.

Older adults are often taking multiple prescription medications, which can lead to dangerous drug interactions, particularly if the medications are not all obtained from the same physician or pharmacist. According to the Substance Abuse and Mental Health Services Administration (SAMHSA), 3 out of 10 adults between the ages of 57 and 85 use five prescription medications or more.

The following 5 resources offer insight into trends and perceptions leading to the under-recognized but growing problem of addiction in the elderly:

Drivers of Abuse Behaviors Differ from Young Adults

The elderly aren’t typically motivated by the same factors that influence teens and young adults to use drugs. Seniors are more likely to abuse alcohol and use prescription medications inappropriately than they are to abuse illegal substances, and they usually don’t do so to seek a “high” or thrill. Instead, the elderly are usually driven by a need or desire to manage physical or psychological symptoms – so they’ll take sleeping pills, anti-anxiety medications and prescription pain medications to do so.

There’s another scenario that occurs among the elderly, as well. If a senior citizen becomes injured or disabled, requiring surgery or suffering from chronic pain, a physician won’t hesitate to prescribe prescription opiates to help manage pain. But with long-term use, even patients who take opiates as prescribed develop a physical addiction to the drug, and stopping the medication suddenly can result in unpleasant withdrawal effects.

Other possible drivers of substance abuse in seniors includes:

  • Grief from death of a spouse
  • Difficult divorce
  • Loss of employment
  • Mal-adjustment to major life changes, such as retirement
  • Cultural experiences that have led to more relaxed attitudes
  • Chronic pain, such as arthritis
  • Recovering from major surgery, such as a hip replacement
  • History of substance abuse

The other problem with opiates is that the body develops a tolerance, meaning a higher dose is required to achieve the same effects. Even if a senior’s intent is to reduce pain to a manageable level, eventually a higher dose will be required in a chronic pain situation.

These 7 resources discuss situational and emotional factors that place seniors at increased risk of substance abuse:

Substance Abuse is More Dangerous for Seniors

Abusing drugs or alcohol is dangerous for an individual at any age, but the elderly population is at greater risk for certain complications and adverse events due to physiological changes that occur with aging. According to the American Society of Addiction Medicine (ASAM), the elderly, cachectic or debilitated patients are more likely to experience respiratory depression and constipation.

According to DrugFree.org (citing research from SAMHSA), “Between 1997 and 2008, the rate of hospital admissions for conditions related to prescription medications and illicit drug use rose by 96 percent among people ages 65 and 84; for people 85 and older, admissions grew 87 percent.” Elderly patients who misuse or abuse their prescribed medications are increasing their risk of dangerous side effects, such as drug-induced delirium or dementia, SAMHSA points out. Yet the non-medical use of prescription medications continues to rise in the older adult population.

The signs and symptoms of substance abuse can be easily confused with symptoms of comorbid conditions. Family members, for instance, may assume symptoms such as memory loss are resulting from progression of Alzheimer’s disease, when in actuality they’re being caused by misuse of medications or adverse drug interactions.

Potential risks of drug or alcohol abuse and/or addiction for seniors:

  • Increased sensitivity or decreased tolerance (less substance produces stronger effect)
  • Higher blood concentrations due to slow metabolism
  • Risk of accidents, falls or injuries
  • Excessive daytime drowsiness
  • Disorientation or delirium
  • Significant memory problems
  • Slowed respiration
  • Worsening liver disease, cardiovascular disease, or diabetes
  • Sleep disruptions or disorders
  • Ulcers and gastrointestinal problems
  • Adverse drug interactions resulting in seizure, coma or death

When prescribing opioids to elderly patients, physicians often start at one-third to one-half the typical dose. Elderly patients should also be more closely monitored through the course of treatment. But physicians alone cannot monitor patients continuously, so caregivers and family members must also pay close attention and watch for potential signs of abuse or dangerous side effects.

These 7 resources discuss the potential dangers associated with misuse of prescription drugs and substance abuse in the senior population:

Addiction Detection by Loved Ones

Elderly patients are often reluctant to seek help out of fear of losing independence. It’s not uncommon for seniors to hide problems, such as difficulty ambulating or frequent falls, from loved ones to avoid becoming a burden. They may be embarrassed or ashamed to admit they have a substance abuse problem, or they may be in denial, refusing to consider the idea that a substance abuse problem exists.

Likewise, addicted persons are unlikely to willingly and intentionally seek out help without intervention, so the odds of a senior citizen with an addiction problem self-identifying and seeking treatment are slim.

Family members may notice warning signs but brush them off as typical symptoms of aging. That’s why it’s important to be aware of the potential for drug abuse in the senior population and pay close attention to potential warning signs.

Some warning signs of substance abuse in the elderly include:

  • Weight loss and/or decreased appetite
  • Memory loss
  • Agitation or irritability; short temper not typical of the individual
  • Mood swings, unusual sadness or depression
  • Sudden increase in anxiety
  • Difficulty concentrating or paying attention
  • Complaints of insomnia
  • Difficulty making decisions
  • Hiding or lying about drinking habits
  • Signs of withdrawal, such as tremors
  • Hiding alcohol or pills
  • Forgetfulness or blackouts
  • Social withdrawal; lack of desire to participate in usually enjoyable activities
  • Discomfort or embarrassment when asked about substance use

Check out these 5 resources to learn more about the warning signs and risk factors for elderly substance abuse:

If you Suspect Drug Abuse: Interventions for Seniors

Discussing sensitive issues with an aging loved one, particularly a parent, can be uncomfortable. Many adult children put off the task of talking with their aging parents about advance care planning, driving safety concerns and similar issues as long as possible. But like many of these other sensitive issues, substance abuse in the elderly poses serious risks – too serious to be ignored.

But healthcare providers only see their patients on a limited basis, so it’s easy for seniors to mask an addiction problem in the outpatient clinical setting. Often, it’s a concerned family member or caregiver who alerts healthcare providers of a potential problem.

These 5 resources offer information on initiating discussions with aging loved ones when you suspect substance abuse and other ways to seek help:

Prevention and Awareness Resources on Addiction Prevention for Seniors

As with any age group, prevention of addiction among seniors is the best solution for the growing epidemic. “Older patients are more likely to be prescribed long-term and multiple prescriptions, and some experience cognitive decline, which could lead to improper use of medications,” according to a report from DrugAbuse.gov.

For this reason, family members and/or caregivers should be carefully monitoring medication management for aging adults. Keeping the home free of expired medications and prescriptions that are no longer being used helps prevent accidental drug interactions and improper dosing.

Tools such as medication dispensers enable caregivers to sort multiple medications into individual containers for morning, afternoon and evening doses to simplify complex regimens for aging adults. Being involved with medication management makes it easier to detect potential patterns of abuse before they become a much larger problem. If you’re dispensing the medication, for example, it’s easy to detect missing painkillers and other medications, indicating that your elderly loved one may be taking additional doses to try to self-manage symptoms.

For more information on prevention strategies and substance abuse awareness, check out the following 6 resources:

Rehabilitation and Treatment for Seniors

There’s been more research on the successful treatment of addiction in the elderly population in recent years, but there are still many misconceptions, even in the healthcare profession. Substance Abuse Among Older Adults, a publication of the U.S. Department of Health and Human Services, points out several myths surrounding substance abuse treatment in the elderly population:

  • Treating addiction in elderly patients is not worthwhile.
  • Alcohol and substance abuse problems cannot be successfully treated in the aging population.
  • Treating substance abuse problems in seniors is a waste of healthcare resources.

But these misconceptions represent a dangerous way of thinking. Potential drug interactions and the tendency of alcohol and drug abuse to trigger new chronic health problems or worsen existing problems make substance abuse in the elderly a serious health concern. Further, research has shown that substance abuse can be successfully treated in seniors.

Treating chronic pain in patients with substance abuse disorders is challenging, but a number of treatment models and frameworks have emerged that aim to minimize risks. With careful monitoring and evidence-based methodology, it’s possible to effectively manage chronic pain without jeopardizing recovery.

These 5 resources offer helpful information on rehabilitation and treatment options for seniors:

With more research illustrating the prevalence of substance abuse among senior citizens and the effectiveness of targeted treatment options, there is hope for families of aging loved ones concerned for their elderly loved one’s health and safety. Caregivers should be aware of the risk factors and potential warning signs to address suspected substance abuse as soon as it’s recognized, so that treatment interventions can be discussed with clinicians as soon as possible.