ABUSE OF PRESCRIPTION AND LICIT PSYCHOACTIVE SUBSTANCES BY THE ELDERLY - ISSUES AND RECOMMENDATIONS

The abuse of prescription and over-the-counter psychoactive medication s, tobacco, caffeine or alcohol (ethanol) by elderly adults is a clini cal situation that many physicians encounter. The issues of diagnosis and clinical presentation of drug abuse may differ in the elderly comp ared with younger individuals, and physicians need to be aware of thes e issues to ensure the most appropriate management of elderly patients . Cognitive (e.g. memory loss), physical (e.g. falls) and behavioural (e.g. depression, insomnia) changes may be signs of substance abuse in elderly individuals. However, these signs may be misdiagnosed as bein g due to aging. The quantity of the substance(s) used by elderly perso ns may underestimate the frequency and severity of problems as, due to altered pharmacokinetics and pharmacodynamics, the elderly are more s ensitive to the effects of many; drugs. Hypnosedatives are among the m ost commonly used psychotropic medications in the elderly and they hav e a high potential for abuse. The elderly are very sensitive to the CN S depressant effects of these drugs and, as a result, misuse (e.g. uni ntentional overuse) can lead to dependence and abuse. There is limited information on the abuse of opioid analgesics, but their misuse can r esult in physical dependence. Although the prevalence of tobacco smoki ng is relatively low among the elderly, older smokers tend to smoke mo re and be more dependent on nicotine than their younger counterparts. Quitting smoking in old age has significant health benefits, and incre ased age has been found to be associated with an increased success in achieving abstinence. Caffeine, consumed mainly in the form of tea, ma y contribute to insomnia and complaints about sleep quality, especiall y among the institutionalised elderly Ulcers, pancreatic cancer and os teoporosis have been related to caffeine intake in some, but not all, studies. Alcohol abuse, dependence and associated problems are less li kely to be detected in the elderly because many of the diagnostic crit eria (e.g. work-related problems) do not apply. Elderly patients in ac ute alcohol withdrawal may require more careful management than younge r ones. Prevention strategies for substance abuse range from the educa tion of patients, physicians and other healthcare workers to monitorin g, regulations and legislations by governments. Future research should aim to improve the diagnosis and detection of substance abuse, and to develop treatment and prevention programmes.