Discover Recovery highlights addiction, dementia in seniors
BUTLER TWP — The Ellen O’Brien Gaiser Center held its fourth annual Discover Recovery symposium Wednesday, March 11, at Butler County Community College. The forum addressed two issues increasingly affecting older adults: dementia and addiction.
And for a doctor making a diagnosis, the two can look pretty similar, according to Dr. C. Thomas Brophy, the center’s medical director. Both can cause difficulty remembering, falling, confusion and behavioral changes, he said.
“A substance use disorder can also mask the memory impairment because it can be attributed to alcohol or something like that,” Brophy said.
He added dementia patients may take a long time to find the right words, but they wouldn’t slur their words like someone under the influence of substances.
Doctors work out whether they’re working with dementia or substance use by making a differential diagnosis that includes listing all the options and narrowing them down.
However, narrowing them down may require examinations, screenings, imaging and toxicology. Other times, all it takes is a list of prescriptions the patient is taking.
Lindsay Scott, a pharmacist at Butler Memorial Hospital for 19 years, said older adults are commonly prescribed opioids, benzodiazepines or other addictive medications for chronic pain.
Older adults metabolize medications slower than younger people, which leads to a buildup of the medication in the body, she said. The buildup can cause side effects that look similar to dementia and substance use.
Scott added she sees 20 to 25 patients per day with nurses, and typically one or two are there for unwanted medication side effects. In these cases, stopping medications abruptly can worsen side effects.
“It’s hard to see that line, so dramatic changes are what you should look for,” Scott said.
She said dramatic changes often signal substance use while gradual decline signals changes in brain physiology.
Brophy brought back memories for many audience members when he discussed going into hospitals in the 1990s and early 2000s and seeing signs in every room that said “pain is the fifth vital sign.”
“Things were changing around that time, and the thought process was, we should eliminate all suffering,” Brophy said.
Brophy said the older “pull yourself up by your boot straps” generation was more likely to tough it out when experiencing pain and would often be prescribed opioids.
“Well, then, all of the sudden, we end up with an opioid epidemic,” he said.
Scott added older adults may have been more likely to use substances in their youth and were more conditioned to take medication for treatment compared with younger generations.
The thought process has shifted with younger generations, such as the belief that pain is a sign an injury isn’t finished healing. Non-opioid medications that treat pain have also become more common to manage chronic pain.
Today, primary care physicians also have less time with their patients than ever before, which can lead to misdiagnosis.
“Your PCP now has 11 to 13 minutes to see you before they have to get with the next patient. That’s not enough time,” Brophy said.
Brophy also said older adults are more likely to take supplements that aren’t regulated by the Federal Drug Administration. Financial flexibility and levels of socialization also affect addiction and dementia care.
“Addiction and isolation always go hand in hand like recovery and community go hand in hand,” Brophy said.
