Aging Drugs And Alcohol One of

the most important developments of the twentieth century has been the enormous rise in worldwide population in general, and especially the survival of an estimated six hundred million people aged sixty or older (Ikels, 1991). The increase in the percentage of elderly in the total population results from medical, economic, and social factors plus a decline in the birthrate. According to 1989 U.S. Bureau of the Census figures, persons over sixty-five represented 12 percent of the U.S. population, and it is projected that this proportion will almost double by the year 2030—since the baby-boom generation, born after 1945, will start reaching 65 in 2010.

This fastest-growing segment—the elderly— uses pharmacological and health services more often than any other part of the population (Brock, Guralnik, & Brody, 1990). Aging people are more susceptible to infectious disease. Many suffer from multiple chronic diseases and often from conditions that have grown slowly worse throughout their lifetimes. Some conditions are the result of accidents and some are from degenerative diseases. The latter include many kinds of cancer; diseases of the immune system such as lupus; diseases of the heart and blood vessels such as stroke and hardening of the arteries; diseases of the glands such as diabetes; bone and joint diseases such as arthritis and osteoporosis; and diseases of the lungs such as emphysema. Like the rest of the population, the elderly also suffer from psychiatric disorders, some of which may respond to medication. Hence physicians (sometimes multiple physicians) often prescribe multiple medicines for treatment. If each physician does not know all the medications prescribed by all the other physicians treating the patient, two or more of these medications may interact, sometimes even causing death (Monane, M;

Monane, S; & Semla, 1997; Stein, 1994). Although they comprised only 12 percent of the U.S. population in 1988, the aging accounted for 35 percent of prescription-drug expenditures (Health Care Financing Administration, 1990). Furthermore, the elderly—like the rest of the population—may also take over-the-counter drugs such as aspirin or allergy tablets, smoke tobacco, drink caffeine-laden and alcoholic beverages, and even use illicit drugs. Because of certain changes in their bodies, their responses to all medicines and to the interactions of one drug to another drug, and of medicines to alcohol, may differ from those in younger people (Montamat, Cusack, & Vestal, 1989).

The use and abuse of ALCOHOL is a public-health problem. Among people sixty-five years of age and older, 33 percent report using some alcohol (National Household Survey on Drug Abuse, 1999). About 6 percent of the elderly are considered heavy drinkers (more than two drinks per day), but about 5 to 12 percent of men and 1 to 2 percent of women in their sixties are problem drinkers (Atkinson, 1984). Alcoholism and prescription-drug abuse may result in physical, psychological, and social illnesses and premature death among the elderly from either severe withdrawal symptoms, medical complications, or suicide. Medicines intended to affect the mind (including ones intended to combat psychosis, depression, anxiety, and sleep problems) are commonly prescribed for the elderly (Rummans, Evans, Krahn, & Fleming, 1995). Studies suggest that the BENZODIAZEPINES or other SEDATIVE-HYPNOTICS are the most commonly prescribed classes of these medicines. The effects of these medicines add to and interact with those of alcohol (Scott, 1989). All these factors taken together—alcohol, old age, multiple diseases, and multiple medications—can lead to poisonous, even fatal, interactions of two or more medicines. The complexities of alcohol, age, and drug interactions are discussed in the sections that follow.

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