Depression & Substance Abuse in Older Adults
Depression and substance abuse are growing problems among older adults.
There are many causes that contribute to this dilemma. One factor is that elderly individuals are more reluctant than members of other age groups to report depressive symptoms or access treatment – and, as a result, they frequently turn to substances to help deal with their depression.
Also, more than any other age group, older adults are likely to be instructed to take prescription medications, which increases the likelihood that they will misuse, use erratically, or abuse those drugs.
OBSTACLES TO DIAGNOSIS
Currently, significant barriers block the effective treatment of depression and substance abuse among older adults. Both conditions are underreported, as older patients are less likely to seek help and physical health care providers are often unwilling or unable to diagnose these disorders in elderly patients.
Most standard criteria for the diagnosis of depression and mental illness have been developed and validated for younger adults. Thus, even when older adults report symptoms and seek help, their depression and substance abuse is often ignored or misdiagnosed, because symptoms of these disorders tend to present differently in older adults than in other age groups.
Some of the signs and symptoms of depression are often discounted as normal facets of aging, and can be difficult to discern among the range of other physical, emotional, and social conditions that can affect the members of this vulnerable group. Substance abuse or misuse by an older adult can be difficult to detect in an individual who is already suffering serious physical symptoms and taking a wide range of prescribed medications.
OLDER ADULTS AT RISK
According to the National Mental Health Information Center, which is part of the Substance Abuse and Mental Health Services Administration (SAMHSA) Center for Mental Health Services (CMHS), older adults are currently overrepresented among adult suicide deaths.
Elderly individuals comprise 13 percent of the national population, but they account for 18 percent of all suicide deaths. And according to Mental Health: A Report of the Surgeon General, 60 to 75 percent of adults over the age of 75 who commit suicide have diagnosable depressive symptoms.
Also, SAMHSA’s Center for Substance Abuse Treatment estimates that up to 17 percent of adults over the age of 60 (approximately 8 million people) abuse substances – primarily alcohol, prescription drugs, and over-the-counter medication.
Significantly, the link between older adult depression and substance abuse appears to go both ways. A 1991 study that was published in the British Journal of Psychiatry found that substance abuse in older adults – particularly heavy alcohol consumption – is a strong risk factor for depression. Conversely, a report in the January 1997 edition of the Journal of the American Geriatric Society reported that depressed older adults frequently experience disrupted sleep and even insomnia, which has been linked to the chronic use of benzodiazepines (a family of commonly prescribed tranquilizers).
A SERIOUS & GROWING THREAT
Depression and substance abuse represent serious threats to aging adults. Although the incidence of major depressive disorder has been found to decrease with advancing age, aging adults report increases in a variety of depressive symptoms.
These symptoms, which often present differently from those of other ages groups, frequently include disturbed sleep, a lack of appetite, and the amplification of physical ailments.
In addition to promoting substance dependency in patients, the exacerbation of these physical symptoms often leads physical health care providers to over-prescribe medication and overlook the related mental health condition – which, in turn, can lead to the overuse of the medication and the further intensification of the physical and mental issues.
Although treatment for depression in older adults shows a high success rate (the surgeon general’s report indicates a 60 to 80 percent positive response rate), treatment for older patients appears to require more time than for other adults. For elderly individuals with limited resources, accessing adequate treatment can be difficult.
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