The use of prescription drugs among elderly Finnish men

The extent and factors that influence drug use were studied in two rural cohorts of Finnish men. The men aged between 65 and 84 years belonged to the Finnish study population of the 25-year follow-up of the 'Seven Countries Study'. Of the original 1,711 men in 1959, 766 were still alive in 1984. The participation rate in the follow-up was 93%. Of the non-institutionalized men (n = 675), 66% had used prescription drugs, and 36% non-prescription drugs, while 25% had not used any drugs during the week preceding the study. The number of drugs in use was highly dependent on the time period covered in the assessment. The number of prescribed drugs was associated with the number of symptoms experienced (P less than 0.001) and the use of OTC-drugs (P less than 0.05). Drug use was not associated with socio-economic variables. Standardized measurement methods are needed in the assessment of drug use to obtain more reliable and comparable results in different populations.

Clinicians, the Elderly and Drugs

The increase of the elderly within our population makes for increased chronic disease and, hence, greater use of sophisticated medications now available. This paper reviews current knowledge of the pharmacodynamics and pharmacokinetics among elderly users of drugs and estimates the prevalence of use of prescribed drugs. Less is known of specifics of prescribing patterns, but evidence clearly suggests the strong influence of patient/doctor communication in compliance and control of side effects. There is little hard evidence on the populations considered at high risk for inappropriate prescribing and use and for side effects. The influence of race, socioeconomic class and age are all suggested Since drugs and their uses increase daily, it is important to investigate the area of high-risk populations in order to accumulate evidence which can lead to appropriate interventions.

Medication and the elderly. Issues of prescription and use

Use of medication has become an increasingly important issue in the health and health care of older populations. The demographic changes resulting in greater numbers of individuals 65 and over, accompanied by a higher prevalence of chronic disease, focus attention on prescription and over-the-counter drugs, the major strategy in treatment regimens for these conditions. In addition, the numbers of new and powerful drugs being developed increase daily. This article reviews and evaluates existing information on the prevalence of medication use and adverse drug reactions. It examines the role of physicians and patients in occurrence and management of side effects of drugs and in patterns of prescription and use. Following this, it identifies areas of research necessary to address the gaps in the current state of knowledge in these areas and discusses the need for strong and substantial information about this essential therapeutic strategy in health care for older people.

Psychoactive drugs, alcohol, and stress and coping processes in older adults

Data are presented on a) the relationship between psychoactive substance use and personal characteristics, b) the relationship between psychoactive substance use and appraisal of and coping with stressful situations, and c) the use of psychoactive substances specifically to cope with stress among older people. Data were provided by 141 65-to-74-year-old retired Caucasians who were assessed repeatedly over 6 months. Compared to national samples, subjects were relatively heavy users of alcohol and average users of psychoactive drugs. Use of alcohol increased with income, and drug use was associated with several psychosocial characteristics as well as with psychological and somatic health. Psychoactive substance use did not relate to the ways subjects appraised and coped with stressful encounters. Further, only a small number of subjects used drugs or alcohol specifically to help them cope in these encounters. The findings about psychoactive drug users are compared with other findings about misusers of drugs, and the risks associated with each type of drug use are discussed.

Differential diagnosis of psychiatric comorbidity in substance abusers

The differential diagnosis of psychiatric comorbidity in substance abusers is important in order to provide effective pharmacological and psychotherapeutic treatments for the comorbid psychiatric disorders. Differential diagnosis of an underlying psychiatric disorder depends on the type of drug abused and the phase of abuse, ranging from acute intoxication to withdrawal. This review derives guidelines for differential diagnosis based on multiple examples of interactions between major psychiatric disorders and various abused drugs.

Unrecognized drug dependence in psychiatrically hospitalized elderly patients

The psychiatric in-patient records of 90 patients greater than or equal to 65 years of age were reviewed retrospectively to determine the prevalence of chemical dependence and if lack of recognition and treatment of chemical dependence resulted in serious complications. Nineteen of the 90 patients were characterized as drug dependent and ten of these patients were neither recognized nor detoxified. Seven of the ten nondetoxified patients, but only one of the nine detoxified patients, experienced serious medical complications typically requiring transfer to a medical floor or medical intensive care unit. Unrecognized chemically-dependent patients were significantly more likely to be female benzodiazepine abusers, while recognized chemically dependent patients were significantly more likely to be male alcohol abusers.

Drug and alcohol abuse among the elderly: is being alone the key?

Despite the rising incidence of drug and alcohol abuse among the elderly, information concerning the social and psychological factors fostering such abuse is scanty and potentially biased toward the limited number of older abusers who obtain professional help. Using a brief interview with carefully selected samples, the present study compares characteristics of social background and social support among 21 older clients (age 55 and over) of drug treatment facilities, 30 older abusers not in treatment, and 155 elderly nonabusers. Analyses suggest that age and gender affect the likelihood of receiving treatment for substance abuse more than the likelihood of being an abuser. Controlling for age and gender effects, substance abuse appeared more prevalent among single and divorced elderly and among respondents who lived alone; presence or absence of living companions was more influential than relationships with nearby social supports. Implications for health and social service programs as well as for further research are discussed.

Mental health problems and aging: a short quiz

The mental health needs of older adults remain largely unmet. This gap is due, in part, to a lack of adequately trained professionals and paraprofessionals. The sixteen-item quiz presented in this article has two purposes: 1) to present an overview of salient empirical and theoretical issues in the area of mental health and aging, and 2) to promote discussion of these topics. Each item is documented with supporting literature. In addition, average scores, item difficulties, and item-to-total correlations are presented for two groups of undergraduate students.

Knowledge of and compliance with drug regimens in the elderly

In an interview study of 545 patients recently discharged from The Johns Hopkins Hospital, data were collected on the patients' knowledge of their diseases, knowledge of drug purpose, and compliance with the prescribed drug regimen. The interrelationships of these variables were compared in patients under age 65 and patients aged 65 or older. Age-related factors and trends were sufficiently important to warrant further investigation. Knowledge of and compliance with drug regimens may reflect doctor-patient relationships. Understanding the patterns of drug use offers a potential for appropriate strategies in clinical practice.