Aging, Mental Health, Depression, Prescription Drugs, Substance Abuse

1. Aging, Mental Health, Depression, Prescription Drugs, & Substance Abuse 1

2. Learning ObjectivesParticipants will be able to Identify usual aging processes Recognize signs and symptoms of dementia and Alzheimer�s Disease Know signs and symptoms of alcohol and drug abuse Recognize signs of potential suicide Identify interactions between medications and alcohol Know how to find help Identify caregiving strategies 2 Psychological, chronological biological, social, and functional dimensions of aging? What is normal? Is it medication interaction; drug use or dementia/Alzheimer�s Psychological, chronological biological, social, and functional dimensions of aging? What is normal? Is it medication interaction; drug use or dementia/Alzheimer�s

3. Normal Aging: What is �Old�? Aging is mostly �attitude,� but is affected by biology too Demographics The fastest growing group is people age 85+ (the majority are females) with increase in the number of people age 100 and older By 2030 one of every five Americans will be age 65 and older 3

4. Mind/Body Interaction: Illness, Medication, Lifestyle Physical illnesses, stress, and disabilities affect brain function and chemistry Medication interactions Poor nutrition Inactivity Lack of physical exercise Head injury Metabolic changes (salt, water ratio) Heart, lung, kidney problems Infections Sensory loss (vision, hearing, speaking) 4

5. The Normal Aging Brain Some memory loss is normal but gradual �Senior Moments� and �It�s on the tip on my tongue� Short term memory most affected Long term memory least affected Forgets names but not faces Confuses timing of events Age of loss varies with individual, although not much loss before age of 70 Affected by poor nutrition; life long stress; other illnesses such as Parkinson�s Disease; depression; alcoholism 5

6. Dementia Neurological disorder that causes general and progressive problems affecting Memory Learning new information Communicating Making good judgments Coordination� Usually accompanied by personality and behavior changes Onset is gradual Condition gets progressively worse Other medical conditions such as hypothyroidism and B12 deficiency are ruled out 6

7. Signs and Symptoms Suggesting Dementia Becomes lost or disoriented Has difficulty performing familiar tasks Cannot make decisions Repeats things Displays poor grooming Wears inappropriate clothing Problems with language Disoriented to time and place Has poor or decreased decision-making abilities Has problems with abstract thinking Misplaces things Experiences changes in mood or behavior Experiences changes in personality Loss of initiative Becomes accusatory and aggressive 7

8. Incidence of Dementia 4 million Americans have dementia 5% of people over age 65 and 20% of those over 85 have some degree of dementia Alzheimer�s disease accounts for 60% of all cases of dementia 15-20% caused by strokes (vascular dementia) 15-20% results from other neuro-psychological disorders, i.e. Parkinson�s disease and Huntington�s disease 8

9. Dementia and Alzheimer's Disease Everyone who has Alzheimer�s disease has dementia Not everyone who has dementia has Alzheimer�s disease Not the same progression for everyone but predictable stages, Diagnosis: Ruling out other disorders � the only true diagnosis for Alzheimer�s Disease is finding �plaques and tangles� in the brain during autopsy after death Complete medical history Medical tests � such as tests of blood, urine, or spinal fluid Neuropsychological tests to measure memory, problem solving, attention, counting, and language Brain scans 9 Diagnosis A complete medical history includes information about the person's general health, past medical problems, and any difficulties the person has carrying out daily activities. Medical tests � such as tests of blood, urine, or spinal fluid � help the doctor find other possible diseases causing the symptoms Neuropsychological tests measure memory, problem solving, attention, counting, and language Brain scans allow the doctor to look at a picture of the brain to see if anything does not look normal Diagnosis A complete medical history includes information about the person's general health, past medical problems, and any difficulties the person has carrying out daily activities. Medical tests � such as tests of blood, urine, or spinal fluid � help the doctor find other possible diseases causing the symptoms Neuropsychological tests measure memory, problem solving, attention, counting, and language Brain scans allow the doctor to look at a picture of the brain to see if anything does not look normal

10. Alzheimer�s Disease Disease of the brain Causes injury to nerve cells in the brain Results in disrupted memory, thinking and functioning Somewhat greater risk for people with family history of Alzheimer's disease Race or ethnicity does not seem to be a factor 10

11. Definition of Mental Health One�s ability to deal with the issues of life in an effective, if not pleasurable or satisfying manner A person�s ability to successfully work, to sustain meaningful loving interpersonal relationships, to take pleasure from life, to contribute to a higher good and the well being of self and others to sustaining ones own sense of self worth 11

12. Depression 12

13. Depression in the Older Adult Treatment complicated by other illnesses and aging body functions Physicians may overlook, assuming symptoms are a normal part of aging Loss and grief are part of everyday life Physical limitations Loss of purpose (retirement) Loss through death Depression is a treatable medical illness 13

14. Suicide Risk Suicide is the major consequence of undetected and untreated depression Greatest risk factors of suicide in older adults Living alone Being male Experiencing the loss of spouse Failing health Use of alcohol 14

15. Warning Signs of Potential Suicide Extreme mood or personality changes not related to dementia or other diagnosed illness Talking about death and suicide Preoccupation with the continuing the struggle of daily life Feeling helpless and hopeless Giving away cherished objects Disturbance in sleeping or eating Severe threat to self or self-worth Extended grief following death of loved ones�� 15

16. Prescription Drug Usage Among Older Adults (age 65+) Older adults use 1.5 billion or 30% percent of all prescription drugs and 40% percent of all over-the-counter drugs (US Food and Drug Administration, 2004) Estimates vary of average number of medications older adults take each day � up to 20 or more 16

17. Over the Counter Drug Usage of Older Adults � OTC 87% of older individuals (mean age 74.5 years) reported regular use of at least one OTC medication 57% reported taking five or more OTC medications daily Given the recent rise in use of �nutriceuticals� such as herbal remedies, these figures are likely to be underestimates 17

18. Aging and Addiction in Older Adults Prescription medication misuse is the most common form of drug abuse among older adults Drug misuse is the under-use, overuse, or erratic use of medications 17% abuse alcohol and drugs Alcohol continues to be the leading cause of addiction in older adults It is estimated that 25 million older adults have problems related to alcohol Rates for hospitalizations due to alcohol-related problems among older adults are similar to those for heart attacks 18

19. Aging and Addiction in Older Adults Less than 2% of alcohol or drug treatment admissions in 1997 were for persons 55 and older Studies show that half of all tranquilizer prescriptions for older adults were inappropriate 19

20. Signs of Possible Alcohol Misuse or Abuse in Older Adults Changes in sleeping and eating patterns Confusion or disorientation Malnutrition Poor hygiene Neglecting one's appearance Slurred speech Incontinence Difficulty urinating Tremors Shakiness Frequent falls and bruising 20

21. Signs of Possible Alcohol Misuse or Abuse in Older Adults Physical effects of alcohol Drink to �calm my nerves,� forget worries, or reduce depression Lose interest in food Gulp drinks down fast Lie or try to hide drinking habits Drink alone more often Hurts self, or someone else, while drinking Were drunk more than three or four times last year Need more alcohol to get "high" Feel irritable, resentful, or unreasonable when not drinking Have medical, social, or financial problems caused by drinking 21

22. Effects of Alcohol Misuse Because alcohol affects alertness, judgment, coordination, and reaction time, drinking increases the risk of falls and accidents Takes less alcohol to affect older people Over time, heavy drinking permanently damages the brain and central nervous system, as well as the liver, heart, kidneys, and stomach Alcohol's effects can make some medical problems hard to diagnose For example, alcohol causes changes in the heart and blood vessels that can dull pain that might be a warning sign of a heart attack 22

23. Effects of Alcohol Misuse May cause forgetfulness and confusion, which can seem like Alzheimer's disease Older persons who abuse alcohol are also more likely to be malnourished These symptoms can also be caused by other medical problems 23

24. When is Alcohol a Problem? What time of the day? How often? What is going on when drinking? How much is the person drinking? Why? (Trigger) Safety Self care Relationships Physical problems Thinking and reasoning (cognitive impairment) 24 Define tolerance � Needing increasing amounts of substance to achieve same effect. Ability to carry on a conversation; ability to retrieve information; not just quantity. When? Do they get up in the morning or do they do this in the evening/ is it continuous all day? Do they start after dinner and drink ? Every day? Only when company is around? Is this a trigger or it is just social? Dining socially and offering them wine or scotch might be normal as a social interaction or Why? Sad/ Lonely/ Most women drink not to think or feel? Men drink because that is what a man dones/ With many older ones they have always done this but Do they drink Are they taking bas prescribed or for every little chronic and he and pain or to not function Are they sharing medications that others friendly are taking Are they taking meds so not to deal with their family? What is the trigger? Is it pain? Is it family interaction? Quality of life Is this person safe/ Are they a smoker Do they take two Value to go to sleep and smoking? When driving to meet friends and has vodka and tonic and then drives home The tolerance level is difference is different when he is older so he cannot do the same routine as when he was younger Bec abuse older and the processing of alcohol If there is kidney or liver function is snot working as efficiently cannot negotiable that like he used to ADLs � Activities of Daily Living: i.e. getting up and being able to got the bathroom, making your bed, getting dressed, driving on your own How is the normal life affected? How was the medications affecting If you have wine for lunch with your friends are you able to continue to function or do you have to go home and take a nap How is this affecting your family and other relationships? Are you all aging not at the same physiological relate and so one can drink more than the other What is the social consequence of one of the group not being able to �keep up� like they used to do? What are the physical l imitations involved? Fragility? Chronic medical considerations? Ache and pains? Balance problems? Ostemies- colostomy; urostemy; or any other healing area; staples Cognitive impairment Irrational thinking Undefined fears Memory problems � short term memory problems Define tolerance � Needing increasing amounts of substance to achieve same effect. Ability to carry on a conversation; ability to retrieve information; not just quantity. When? Do they get up in the morning or do they do this in the evening/ is it continuous all day? Do they start after dinner and drink ? Every day? Only when company is around? Is this a trigger or it is just social? Dining socially and offering them wine or scotch might be normal as a social interaction or Why? Sad/ Lonely/ Most women drink not to think or feel? Men drink because that is what a man dones/ With many older ones they have always done this but Do they drink Are they taking bas prescribed or for every little chronic and he and pain or to not function Are they sharing medications that others friendly are taking Are they taking meds so not to deal with their family? What is the trigger? Is it pain? Is it family interaction? Quality of life Is this person safe/ Are they a smoker Do they take two Value to go to sleep and smoking? When driving to meet friends and has vodka and tonic and then drives home The tolerance level is difference is different when he is older so he cannot do the same routine as when he was younger Bec abuse older and the processing of alcohol If there is kidney or liver function is snot working as efficiently cannot negotiable that like he used to ADLs � Activities of Daily Living: i.e. getting up and being able to got the bathroom, making your bed, getting dressed, driving on your own How is the normal life affected? How was the medications affecting If you have wine for lunch with your friends are you able to continue to function or do you have to go home and take a nap How is this affecting your family and other relationships? Are you all aging not at the same physiological relate and so one can drink more than the other What is the social consequence of one of the group not being able to �keep up� like they used to do? What are the physical l imitations involved? Fragility? Chronic medical considerations? Ache and pains? Balance problems? Ostemies- colostomy; urostemy; or any other healing area; staples Cognitive impairment Irrational thinking Undefined fears Memory problems � short term memory problems

25. Prescription Drug Abuse and Older Adults - Common Signs and Symptoms Anxiety Confusion Constipation Depression Falling Fatigue Incontinence Malnutrition Memory loss Poor appetite Restlessness Weight Loss 25

26. Prescription Drug Abuse and Older Adults- Issues for older adults Adverse Drug Reactions Cost of medications Not taking those prescribed Medication �swapping� �Polypharmacy� � Taking a  large number of medications Drug Interactions Drug to drug Drug to disease Decline in liver and renal function with age Body composition changes (greater relative fat content, decreased relative free body water) Not following medical advice or taking medication as  prescribed Food-drug interactions 26

27. Sleeping medications (e.g., Ambien, Sonata, Restoril, Halcion, Dalmane) Anti-angina medication (e.g., Isordil, nitroglycerin) Aspirin Flagyl Blood thinners (e.g., Coumadin) 27

28. Preventing and Managing Memory Loss and Depression Health care Nutrition Physical activities Avoid isolation Mental activities Mental exercises to keep the brain strong and flexible such as reading; crossword puzzles to build vocabulary; jigsaw puzzles; games; mental puzzles/quizzes; crafts; writing journals; discussions with others Hobbies Social and civic clubs Continuing education Computer classes/current event seminars 28

29. Help Older Adults Balance Stress of Daily Living with Positive Experiences Environmental � home/nature Social Health 29

30. What to Do? Involve the medical doctor Medical examination Report all prescription drugs, over-the-counter medications, and use of herbal remedies Report observations about alcohol use; encourage the older adult to be candid about use - this is a health issue Encourage working family members to use EAP benefits Call 2-1-1 Mental Health Association Mental Health Mental Retardation Local council on alcoholism and drug abuse 30

31. Resources For Caregivers Call 2-1-1 throughout Texas. Provides information and access to health and human service information for all ages 1-800-252-9240 to find local Texas Area Agency on Aging 1-800-677-1116 - Elder Care Locator to find help throughout the United States Online Family Caregivers Online www.familycaregiversonline.net Online education, resources, links, frequently asked questions Benefits Check-up www.benefitscheckup.org for an online way to determine benefits for which someone qualifies. To schedule a caregiver presentation for your church, business, library, civic group, or other location, call your local area agency on aging or send an email from www.familycaregiversonline.net 31 ReviewReview

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33. What Assistance is Available Through the Area Agency on Aging (AAA)? Caregiver Services Information and referral Caregiver education and training Caregiver respite Caregiver support coordination Case management Transportation assistance Services for persons age 60 and older Benefits counseling Ombudsman - advocacy for those who live in nursing homes and assisted living facilities Home delivered meals Congregate meals Light housekeeping 33

34. Sources As cited in the body of the presentation Caregiver Education, Area Agency on Aging of North Central Texas, Dallas County, and Tarrant County Permission is granted to duplicate any and all parts of this program to use in education programs supporting family members caring for elders This program is one module of a comprehensive caregiver education program Go to www.familycaregiversonline.net for more information about this and other training programs internet links frequently asked caregiver questions legal forms phone numbers and more 34

35. Written by Connie Burdick, LMSW, LCDC Zanda Hilger, M.Ed., LPC (revised 07) Revised 2009 by Zanda Hilger and Betty Purkey Reviewed by Recovery Resource Council (formerly Tarrant Council Alcoholism and Drug Abuse) 35