Warning!! Danger!!! On the Rise Prescription Drugs and Substance Abuse Addiction Among the Elderly...
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Transcript of Warning!! Danger!!! On the Rise Prescription Drugs and Substance Abuse Addiction Among the Elderly...
04/15/2023 2
Ethel D. Callier-Perry, M.A., Ph.D. Candidate
Consultant: Harris County Mental Health Jail diversion Pilot Program.
Kingwood, Texas / Management Consulting
Professional Speaker: ‘Aux Populi’ President/Owner – Ethel D. Callier-Perry
Kingwood, Texas / Professional speaker
Current: Harris County, Walden University
Previous: MHMRA of Harris County, Tri-County MHMR
Education: Walden University – Completing Dissertation – PhD / Health Psychology
Contact: [email protected] (832) 527-1090
Presenter
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John Doe is a 58 y/o AA male who have sustained three major strokes that
have left him paralyzed on his right side & difficulty speaking. He can
comprehend. The hospital started physical therapy, rehab therapy, speech
therapy, & occupational therapy. He discharges to an inpatient rehab facility
to continue his treatment. Once he reached maximum benefit, he was
discharged to a nursing home. Family consisted of siblings who had no
medical knowledge. While at the nursing home, all therapeutic services was
Supposed to continue. One family member noticed that her brother’s condition
had regressed & he was not responsive as before. Questioning the medical
staff never happened until she discussed the case with her husband’s sister-in-
law. The sister-in-law who did not have the knowledge in the area of
medicine and nursing homes, a red flag immediately came up. The sister-in-law
informed the sister of the patient to go to the nursing home & see whether
or not he was getting the medical care that had been Rx’s by the MD & to
review his medications.
Case StudyBeers, M. H., Ouslander, J. G., Rollingher, I., Reuben, D. B., Brooks, J., & Beck, J. C. (1991).
04/15/2023 4
The sister of the brother went one step further & took a good
friend who was an MD with her to the nursing home.
Immediately the MD noted that the brother was being
purposely overmedicated & he was wearing a medication
patch that had expired two months prior for type 2 diabetes,
and there was no diagnostic history. Note reviewing the drug
list that he was taking opioids was inappropriate for his diagnosis, as
well as sleeping agents was inappropriate. Discontinuation of therapy
was an immediate red flag. The family immediately removed their
brother from the nursing home & transferred him to a nursing home
that is properly taking care of their brother
Case Study Cont..
04/15/2023 5
John Doe has made so much progress that he is walking with the
assistance of a walker & he can make short conversations. Today
he is going on weekend passes with family members to spend the
weekend with each of his siblings & attend church services. In the
next couple of months, John Doe will be able to step down to an
Assisted Living Facility & hopefully back to home living with
family members. The frequency of these type of cases are alarming, yet
this is a case where the nursing home used chemical restraints to
manage their patients. Present legal action is in place for this nursing
home. Note that deaths have occurred in the same nursing homes. And
due to this family legal measures against the nursing home, the cases of
those who died in the nursing homes are being re-opened for possibly
death by unauthorized chemical restraints / overdose.
Case Study Cont….
04/15/2023 6
Is this a case of substance abuse? The answer is
no, but every day you have nursing homes that
help turn our geriatrics into involuntary
substance abusers.
The nursing home is the drug dealer forcing the
drugs on our loved ones.
Case Study Cont…
04/15/2023 7
Explicit Criteria for Determining Inappropriate Medication Use in Nursing Home ResidentsMark H. Beers, MD; Joseph G. Ouslander, MD; Irving Rollingher, MD; David B. Reuben, MD; Jacqueline Brooks; John C. Beck, MDArch Intern Med. 1991;151(9):1825-1832. doi:10.1001/archinte.1991.00400090107019.
ABSTRACTIncreasing attention is being paid to inappropriate medication use in nursing homes. However, criteria defining the appropriate or inappropriate use of medication in this setting are not readily available and are not uniform. We used a two-round survey, based on Delphi methods, with 13 nationally recognized experts to reach consensus on explicit criteria defining the inappropriate use of medications in a nursing home population. The criteria were designed to use pharmacy data with minimal additional clinical data so that they could be applied to chart review or computerized data sets. The 30 factors agreed on by this method identify inappropriate use of such commonly used categories of medications as sedative-hypnotics, antidepressants, antipsychotics, antihypertensives, nonsteroidal anti-inflammatory agents, oral hypoglycemics, analgesics, dementia treatments, platelet inhibitors, histamine2 blockers, antibiotics, decongestants, iron supplements, muscle relaxants, gastrointestinal antispasmodics, and antiemetics. These criteria may be useful for quality assurance review, health services research, and clinical practice guidelines. The method used to establish these criteria can be used to update and expand the guidelines in the future.(Arch Intern Med.1991;151:1825-1832)
1304/15/2023
Did you know…… Blow et al., (2002) Older people have a lower
tolerance to specific substances. In comparison to
younger adults the geriatric has an increase
vulnerability to alcohol and an amplified response
to over the counter (OTC) drugs. The Liver enzymes
that help break down the drugs are less efficient
with age, & central nervous system (CNS) sensitivity
increases with age.
If there is a past history of substance abuse, the
elderly is less aware of how their body is not able
to withstand the abuse of prescription drugs,
alcohol, & OTC drugs. Due to age there is a
reduction in lean body Mass Vs. total volume of Fat
= to decrease in total body volume = to an
incline to the total distribution of alcohol & other
chemicals in the body. Any small amounts of substances
such as alcohol or OTC can be problematic for the
elderly (Blow Et. Al., 2002).
Anxiety Tolerance to alcohol or meds Blackouts, dizziness Legal Difficulties Depression Mood Swings Memory loss Disorientation New difficulties in making decisions Poor Hygiene Falls, bruises, burns Family problems Idiopathic Seizures Financial problems Sleep problems Social isolation Incontinence Poor nutrition
Severity of Prescription or Substance Abuse
Signs & Symptoms of Potential Substance Misuse & Abuse in Older Adults
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Fick, D. M., Cooper, J. W., Wade, W. E., Waller, J. L., Maclean, J. R., & Beers, M. H. (2003).
04/15/2023 17
2nd ObjectiveHow to Give Appropriate Intervention to The Severity of Prescription or Substance Abuse
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Outreach services Psychosocial Treatment Education & awareness by seniors & caregivers Cognitive Behavioral Treatment Brief Interventions Peer led self help groups such as Alcohol Anonymous
& Narcotics Anonymous Pharmacological interventions
Interventions Sorocco, K. H., & Ferrell, S. W. (2006)
04/15/2023 25
PreventionSorocco, K. H., & Ferrell, S. W. (2006)
Read the prescription label carefully. When in doubt call your pharmacist or doctor.
Look for pictures or statements on your prescriptions & pill bottles that tell you not to drink alcohol while taking the particular medicine.
If you are taking medications for sleeping, pain, anxiety, or depression, it is unsafe to drink alcohol.
04/15/2023 26
Prevention While at social events – drink
responsibly!!!
If you have never been diagnosed with a drinking problem, one alcoholic drink a day is the recommended limit for anyone over the age of 65.
That's 12 ounces of beer, 1.5 ounces of distilled spirits or 5 ounces of wine.
04/15/2023 29
Public AwarenessSimoni-Wastila, L., & Yang, H. K. (2006)
Information will ensure appropriate provision of behavioral services
Information to build public awareness of medical health services available to the aging substance abuser
Information to help build public awareness
04/15/2023 33
Share the Right Information with Your Health Care Professional
Make a list for your doctor of all your medications (including doses), especially on our first visit. Keep it updated and carry it with you.
Simoni-Wastila, L., & Yang, H. K. (2006)
04/15/2023 34
Share the Right Information with Your Health Care Professional
Remind your doctor or pharmacist about any previous conditions that might affect your ability to take certain medicines such as a stroke, hypertension, serious heart disease, liver problems or lung disease.
04/15/2023 35
Share the Right Information with Your Health Care Professional
Don’t be afraid to ask questions if you don’t know the meaning of a word, if instructions are unclear, or if you want more information.
04/15/2023 36
Share the Right Information with Your Health Care Professional
Whenever possible, have your doctor or a member of the medical staff give you written advice or instructions.
04/15/2023 37
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Articles about Addiction
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The Big Book
The Big Book
First published in 1939 and subtitled The Story of How Many Thousands of Men and Women Have Recovered from Alcoholism, the Alcoholics Anonymous (A.A.) 'Big Book', as it is commonly called, is the first text written about the experiences of the founders of the A.A. movement. It tells the story of Bill W., one of the co-founders of A.A. and how the program worked in the early days of the movement. It is full of much timeless and practical wisdom and is the first standard (and some would say the only standard) text of A.A. and, subsequently, of 12 step programs.You can read the book online (2nd edition) or you can download the book (496 KB download size) in PDF format.A more recent version of the Big Book can also be found online at the A.A. website. The newer versions differ mostly in the stories that are collected at the end of the book about people who have recovered using the 12 step approach
04/15/2023 42
The Big Book Overview
Introduction
Chapter 1 - BILL'S STORY
Chapter 2 - THERE IS A SOLUTION
Chapter 3 - MORE ABOUT ALCOHOLISM
Chapter 4 - WE AGNOSTICS
Chapter 5 - HOW IT WORKS
Chapter 6 - INTO ACTION
Chapter 7 - WORKING WITH OTHERS
Chapter 8 - TO WIVES
Chapter 9 - THE FAMILY AFTERWARD
Chapter 10 - TO EMPLOYERS
Chapter 11 - A VISION FOR YOU
Appendix
04/15/2023 44
ReferencesBeers, M. H., Ouslander, J. G., Rollingher, I., Reuben, D. B., Brooks, J., & Beck, J. C. (1991). Explicit criteria for determining inappropriate medication use in nursing home residents. Archives of internal medicine, 151(9), 1825-1832.
Blow, F. C., Oslin, D. W., Barry, K. L. (2002). Misuse and abuse of alcohol, illicit drugs and psychoactive medications among older people. Generations , 26 (1), 50 - 55.
Compton, W. M., & Volkow, N. D. (2006). Abuse of prescription drugs and the risk of addiction. Drug and alcohol dependence, 83, S4-S7. Bartels, S. J., Blow, F. C., Brockmann, L. M., & Van Citters, A. D. (2005). Substance abuse and mental health among older Americans: The state of the knowledge and future directions. WESTAT, Rockville, MD. Retrieved, from the World Wide Web: http://www. samhsa. gov/aging/SA_MH_% 20AmongOlderAdultsfinal102105. pdf. pharmacotherapy, 4(4), 380-394.
Fick, D. M., Cooper, J. W., Wade, W. E., Waller, J. L., Maclean, J. R., & Beers, M. H. (2003). Updating the Beers criteria for potentially inappropriate medication use in older adults: results of a US consensus panel of experts.Archives of internal medicine, 163(22), 2716-2724.
Han, B., Gfroerer, J. C., Colliver, J. D., & Penne, M. A. (2009). Substance use disorder among older adults in the United States in 2020. Addiction, 104(1), 88-96.
Juurlink, D. N., Mamdani, M., Kopp, A., Laupacis, A., & Redelmeier, D. A. (2003). Drug-drug interactions among elderly patients hospitalized for drug toxicity. Jama, 289(13), 1652-1658.
Simoni-Wastila, L., & Yang, H. K. (2006). Psychoactive drug abuse in older adults. The American journal of geriatric pharmacotherapy, 4(4), 380-394.
Sorocco, K. H., & Ferrell, S. W. (2006). Alcohol use among older adults. The Journal of general psychology, 133(4), 453-467.
http://www.12step.org/references/the-big-book/