News stories are warning that the opioid crisis has hit senior citizens in a big way, which certainly caught my eye this week because older people can be especially vulnerable to medication issues, but also to pain.
How the body metabolizes substances can change with age, though reaction to medications varies from person to person and drug to drug. Drug trials don't always focus on figuring out what's happening with an older population, unless the product is being produced specifically for an illness that mostly afflicts the aged.
It is also true that people can become wobblier as they get older, so part of the ongoing discussion takes on added urgency because an individual who's already more apt than the general population to fall could be made further vulnerable by opioids.
Bowling Green State University's Optimal Aging Institute says prescription opioid deaths more than doubled for people 65 and older between 1999 and 2015.
The federal Substance Abuse and Mental Health Services Administration shows a projected doubling, too, but couches it differently. "The population of older adults who misuse opioids is projected to double from 2004 to 2020, from 1.2 percent to 2.4 percent."
But the conversation makes me feel uneasy. I fear there's a paternalistic tone. Too often, we discuss issues concerning children and older adults with exactly the same inflection, a sort of sing-songy "we know what you need" quality, as if there's a spot on the calendar when a senior is suddenly immature and unable to make any decisions. Look, they're kids again.
Except they're not.
While someone with dementia or decreased mental capacity because of a medical condition may not be capable, most seniors want, deserve and are capable of making informed decisions and being part of a robust and thorough discussion of their medications and potential problems. And one thing that most older people I know have that younger people lack is a realization they can withstand and survive a certain degree of pain, too. It's part of the long-range perspective that comes with having lived through a bunch of stuff.
I think it's quite likely that when older adults are told their options and the risks that come when opioids are used to manage pain, most seniors will be very careful or will select something else.
The problem is, seniors often get short-changed when it comes to discussion about medicine or care. When younger people take a friend or loved one to a medical appointment to make sure everything's understood, that person is likely to be treated as an observer. But time and again I've seen that when an older person takes someone along, the conversation will be directed to that person, even if the elderly person shows no mental impairment at all. Some caregivers are very good with the elderly, but lots are dismissive, too.
Truth is, opioids caught the whole community, including health care providers, by surprise. It took a while to recognize their addictive quality and the havoc they wreaked. Early on, most doctors and patients weren't having the kind of pros and cons conversations that the substances required.
You can blame a combination of factors, starting with brief patient-doctor encounters that perhaps didn't allow sufficient time. That was exacerbated because opioid addiction wasn't well understood.
We know better now, and it has been a painfully costly lesson.
When it comes to reducing opioid abuse among seniors, I hope much of the focus will be on education and discussion and not ageist attitudes. As SAMHSA notes, "Despite the risks, opioids can be a valuable tool in treating pain and improving quality of life in older adults." Close to half of older Americans have chronic pain, and well-thought-out pain management lets them be independent, it adds.
Benefit-risk decisions will vary from person to person. Most of the time, one of those helping make those decisions should be that patient.