10 - Medication and Substance Use and Misuse in the Elderly

Abstract

Substance use disorders can occur in any age and demographic. It is particularly devastating in the elderly, where comorbid conditions, ill health, and polypharmacy can increase the mortality rate from combined pharmaceutical and chemical effects. Older adults who may already be prone to dizziness or falls can see increased risk and hospitalization with substance use outside of their medication regimen. Although ingestion of alcohol has typically been seen as the most abused substance, recent studies suggest that other substances, including over-the-counter medications, also figure largely in substance misuse in this age group. Multiple reasons for substance misuse have been identified including pain, loneliness, and isolation. This chapter explores substance use, as well as medication diversion and the use of chemical restraints in the elderly, and why those working with the elderly need to be able to recognize signs of substance use in older persons.