The opioid crisis and the elderly
“11.5 million persons reported nonmedical use of prescription drugs in 2016.”1 Even more startling, “134 people die every day from opioid related drug overdoses.”2 This opioid epidemic affects young and old alike. However, the opioid epidemic creates unique problems for the elderly because it affects them in multiple facets of their life.
As one ages, aches and pains may set in. These aches and pains leave the older adult seeking relief from the chronic pain. Older adults may also experience opioid use through a child who is lost in or to a drug addiction, leaving the elder parent to care for his or her grandchildren. Similarly, a family member who is addicted to opioids may try and take advantage of an elder relative they care for or visit, which could inevitably lead to abuse and/or financial exploitation of the older adult. These complex issues make addressing the opioid epidemic and the elderly especially important.
The Elderly and Opioids
A Centers for Disease Control and Prevention study found that in 2016, approximately twenty-seven percent of United States adults aged sixty-five to eighty-four, and thirty-three percent of adults aged eighty-five and above, suffered from chronic pain.3 Although these percentages sound small, this translates to an estimated 13,574,000 older adults experiencing chronic pain.4 With so many older adults suffering, one might ask how to combat their pain? The answer is more complicated than one might first imagine.
In a U.S. Department of Health & Human Services study, it was revealed that approximately one in three Part D Medicare beneficiaries “received a prescription opioid in 2017.”5 “460,000 beneficiaries received high amounts of opioids in 2017,” although this is lower than 2016.6 However, “the population of older adults who misuse opioids is projected to double from 2004 to 2020, from 1.2 percent to 2.4 percent,”7 whereas opioid use in young adults, while still 8.1 percent, has decreased approximately three percent since 2002.8 One major concern with older adults taking opioids is that they face an increased risk of falling.9
Intermixed in this issue of opioid use in older adults is the issue of overmedication, also known as polypharmacy.10 In 2006, approximately fifty-eight percent of older adults aged sixty-five and older “reported taking five to nine medications, and [approximately eighteen] percent reported taking [ten] or more [medications] over the course of that year.”11 The problem with the elderly being overmedicated is that taking multiple medications increases the risk of “dangerous drug interactions and serious side effects.”12 More specifically, overmedication could affect the cognitive and mental capacity of an older adult, leaving them to mimic symptoms of Alzheimer’s or dementia.13
With opioid use continuing to be a rising concern, it is important to always consider if an opioid is necessary or if another treatment could also be effective. Furthermore, Parentgiving suggests having a “brown bag review”, where you take all of the medication to the older adult’s doctor or pharmacist to review, to consider whether some or all of the medication is necessary.14
Grandfamilies and the Opioid Epidemic
“More than 2.6 million children are raised by grandparents, aunts, uncles, siblings, other extended family[,] and close family friends who step forward to care for them when parents are unable.”15 Research has shown that parental substance abuse is the main reason for grandparents stepping in to raise these children who would otherwise go into foster care.16 In fact, experts believe that the recent increase in the number of children going into foster care is the result of the opioid epidemic.17
Although research has shown “that children who cannot remain with their birth parents thrive when raised by relatives and close family friends,” many grandparents need help to maintain their family when grandchildren move in.18 “One in five grandparents raising grandchildren lives below the poverty line,” and “one in four has a disability.”19 These challenges make it difficult for the grandparent to care for his or her grandchildren. Generations United suggests more support services are necessary to assist the elderly in raising their grandchildren of the opioid epidemic.20
Elder Abuse and Financial Exploitation
Approximately ten percent of older adults have suffered from abuse.21 Abusers “are most likely to be adult children or spouses…[who] have a history of past or current substance abuse” and mental or physical health problems.22 A person addicted to opioids may try to steal medications from their elderly family member, steal money from their elderly family member, and/or abuse this family member in the process of feeding his or her addiction.
The financial exploitation by an opioid user could lead to the depletion of an older adult’s life savings and resources needed for his or her long-term care. If medicine used to keep the older adult comfortable is stolen, the older adult could be left to suffer in pain until the theft is discovered. And if the older adult denies the opioid user access to the money or the medicine cabinet, physical abuse could result. Caregivers and family members must stay aware of this possibility in order to protect the elderly from abuse.
The opioid epidemic has a unique effect on the elderly. From personal opioid use to a family member’s opioid use, the elderly face many challenges surrounding the opioid epidemic. However, with awareness of and diligent work to try and address these problems, many of these issues can be attacked head on.
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1. Id. at 6.
3. James Dahlhamer, Jacqueline Lucas, Carla Zeleya, Richard Nahin, Sean Mackey, Lynn DeBar, Robert Kerns, Michael Von Korff, Linda Porter, and Charles Helmick, Prevalence of Chronic Pain and High-Impact Chronic Pain Among Adults—United States, 2016, Centers for Disease Control and Prevention (Sep. 14, 2018), https://www.cdc.gov/mmwr/volumes/67/wr/mm6736a2.htm#suggestedcitation.
5., U.S. Department of Health & Human Services, Opioid Use in Medicare Part D Remains Concerning, Office of Inspector General (June 2018), https://oig.hhs.gov/oei/reports/oei-02-18-00220.pdf.
7. U.S Department of Health & Human Services, Opioid Use in the Older Adult Population, Substance Abuse and Mental Health Services Administration (Aug. 15, 2017), https://www.samhsa.gov/capt/sites/default/files/resources/resources-opio....
8. U.S. Department of Health & Human Services, Opioid Misuse Increases Among Older Adults, Substance Abuse and Mental Health Services Administration, (July 25, 2017), https://www.samhsa.gov/data/sites/default/files/report_3186/Spotlight-31....
9.Carolina Geriatric Workforce Enhancement Program, Opioids and Fall Risks in Older Adults, National Council on Aging (last visited Oct. 11, 2018), https://www.ncoa.org/wp-content/uploads/Opioids-and-fall-risks-graphic-.pdf (citing Krebs E, Paudel M, Taylor B et al. Association of Opioids with Falls, Fractures, and Physical Performance among Older Men with Persistent Musculoskeletal Pain. JGIM. 2015; 31(5):463-9).
10. Anna Gorman, “America’s Other Drug Problem”: Copious Prescriptions for Hospitalized Elderly, Kaiser Health News (Aug. 30, 2016), https://khn.org/news/americas-other-drug-problem-copious-prescriptions-f....
11. U.S. Department of Health & Human Services, National Action Plan for Adverse Drug Event Prevention, Office of Disease Prevention and Health Promotion (2014), https://health.gov/hcq/pdfs/ADE-Action-Plan-508c.pdf.
12. Gorman, supra note 7.
13. Parentgiving, Overmedication in the Elderly: Polypharmacy a Growing Problem among Seniors, Parentgiving (last visited Oct. 11, 2018), https://www.parentgiving.com/elder-care/overmedication-in-the-elderly/.
15. Ana Beltran, Jaia Peterson Lent, and Adam Otto, Raising the Children of the Opioid Epidemic: Solutions and Support for Grandfamilies, 1, Generations United (2018), https://www.gu.org/app/uploads/2018/09/Grandfamilies-Report-SOGF-Updated....
19. Jaia Peterson Lent, Grandparents are Raising the Children of the Opioid Crisis, American Society on Aging (Apr. 9, 2018), http://www.asaging.org/blog/grandparents-are-raising-children-opioid-crisis.
20. Supra note 15, at 15-16.
21. Mark Lachs and Karl Pillemer, Elder Abuse, 373 New Eng. J. Med. 1947, 1949 (2015).
22. Id. at 1950.