Drug misuse among seniors has become an “invisible epidemic,” or so the government’s Substance Abuse and Mental Health Services Administration believes.

No one really knows how serious this epidemic has become, despite all the surveys and studies conducted by various government agencies and research organizations, and with good reason. Seniors use lots of drugs, probably averaging between three and five prescriptions each, and that’s not counting over-the-counter painkillers and sleep aids, or alcohol.

Too, misuse is hard to spot. Some symptoms of drug misuse by seniors mimic the problems that take them to a doctor in the first place, including common complaints such as fatigue, dizziness, memory lapses, and balance problems.

In short, drug use by seniors is probably undercounted, misdiagnosed, underappreciated, and quickly dismissed because its victims are “old.” Affected seniors and their families may suffer needlessly as a result.

Seniors are not exactly the first group one would suspect of having drug problems, but this “invisible epidemic” does not mean that seniors are “hooked” on illegal drugs (though some may be). Rather, it means that they are affected by the misuse, overuse and/or underuse of legitimately prescribed drugs and readily available over-the-counter medications, possibly combined with alcohol use.

Elusive Numbers

Back  in 2008, an article published, an article published in the Journal of the American Medical Association reported that one third of the 57-85 age group took at least five prescription drugs, while those with serious chronic illness may take more than 20. According to the article, 68 percent also took over-the-counter drugs and supplements. Several years later, the 2019 KFF Tracking Poll reported that 89% of adults 65 or older take a prescription medicine and 54% take four or more different prescription drugs. A 2020 study by the NIH found that older adults are particularly vulnerable to the negative effects of substances and therefore substance misuse, which is often overlooked and undertreated by doctors and caregivers. Furthermore, the study found that substance misuse is an increasing problem among older adults.

Additional Complicating Factors

In addition to drugs prescribed to deal with common chronic health conditions like high blood pressure, diabetes, arthritis and high cholesterol, seniors also turn to medication to reduce pain (OxyContin, Vicodin, for instance), deal with depression and anxiety (Xanax, Valium), sleep better (Ambien, Sonata, Restoril), have more energy and, generally, feel better (Concerta, Adderall).

With such widespread use and for so many problems, and with so many of these drugs heavily advertised, it is easy to understand why it is difficult to assess the problem accurately. A number of other factors provide further complications:

• It might be dismissed as “ageism” because common symptoms of senior drug misuse–among them confusion, fatigue, balance problems, memory loss–mimic problems usually blamed on old age. That means a physician confronted with those symptoms may not pick up the drug misuse relationship, and may even prescribe more drugs to deal with the symptoms. The NIH in its 2020 study found that “These ageist beliefs are a large reason why we see low rates of diagnosis and treatment/services in the older adult population.
• Seniors metabolize drugs and alcohol differently than their younger counterparts; yet seniors are excluded from the drug trials that would pinpoint potential side effects in this vulnerable age group. Consequently, physicians don’t know what side effects may be or what interactions with other drugs to avoid.
• Denial may play a role. Neither seniors nor their families and caregivers want to admit or confront the fact that drug use or misuse, even for legitimately prescribed drugs, might be a problem. Seniors, too, may think their problems are due to age and don’t want to complain or cause trouble.
• As physician visits become shorter, physicians have to address the variety of health problems most seniors have, and that leaves little, if any, time to explore the possibility that drug misuse or interactions could be causing or compounding those problems and provider awareness about available and effective treatment and services..
• Seniors with numerous health issues get prescriptions from many doctors who may not be aware of all the medications a patient takes, or that the senior also uses over-the-counter medications for sleep, cold symptoms and allergies–and may even have a drink now and then.
• Instructions for taking medications may not be clear, or the print may be so small seniors can’t read the instructions and contraindications, or they may have a hearing problem and didn’t understand the instructions. Too, seniors may forget when or how to take a medication–or even forget to take it at all.

Safe Taken as Directed

Most people believe, correctly, that a drug prescribed by a doctor is safe when taken as directed. They also feel that readily available over-the-counter drugs are safe when taken as directed. What they don’t understand is that even taken correctly, some of these medications interact. Antihistamines, for instance, are sedating when combined with an anti-depressant, or even with a glass or two of wine.

Drug “abuse” and drug “misuse” are easily confused. “Abuse” usually involves opioids, stimulants and anti-depressants–some legal, some illegal or illegally obtained–taken to “feel good,” and counter the pain, anxiety and depression that prompted a prescription.

Drug use is considered “misuse” when a drug properly prescribed for a given condition is not being used properly. That happens for a variety of reasons. Maybe the directions are confusing or unclear, or the senior can’t read the fine print. Maybe the senior increases the dose believing that if some is good, more is better. That can easily happen when painkillers reach a threshold and don’t seem to work anymore.

Another misuse problem: the senior doesn’t want to run out of a drug so doesn’t take the prescribed amount just to make it last longer. And yet another is saving and then using leftover medicines (codeine cough syrup is a good example) or taking a drug (maybe an antibiotic), that was prescribed for another condition or even for someone else.

Telltale Signs of Misuse

A number of signs might alert you to the possibility of drug misuse. These include:

• Balance problems
• Changes in appetite and sleep patterns
• Delirium
• Memory and cognitive problems
• Defensiveness when asked about medications
• Sneaking and hiding drugs
• Doctor shopping to get new prescriptions
• Use of several pharmacies

And if you do detect a problem, a number of common sense steps will help to counter it:

• Stay connected with your parents and talk with them about your concerns;
• Find out what medications your parents are taking and why;
• Accompany them on doctor visits and take all medications with you;
• Don’t forget to include over-the-counter medications and mention alcohol use, even if it is only a glass of wine with dinner;
• Encourage your parent to use painkillers only when needed to avoid dependence and overdosing
• Take medications to your local pharmacist and ask about interactions;
• Check with your parent’s physician about acceptable alternatives to pain medication, such as heat and/or exercise.

This article has been updated since it originally published in December 2015.