Washington, DC – I walk into the second -floor nursing home room dimly lit by the flickering light of a single candle on the tiny bedside table. Apart from this, there is stunned darkness. It feels slightly cold. The A/C seems to be running on this cold December morning. The nurse walks in gingerly behind me. Earlier, she had asked me to see Mrs. Smith (generic patient name chosen to protect confidentiality). Upon reviewing her records, I had discovered something persistent in the life of this widowed, eighty-five-year-old retired administrative assistant – she had been hospitalized several times in the last five years for narcotic painkiller overdose. She lived alone in a retirement community. She had two daughters, one of who lived out of state. The younger daughter came to see her regularly on days that she could take off from her work as a physical therapist in an outpatient practice.
I see her lying on the bed, writhing in what seems like agonized frenzy. She turns to me and yells, “Doc, you need to give me Oxycodone RIGHT NOW.” She is shaking uncontrollably and moving her arms like snakes fighting each other for territorial integrity. At the same time, she is mouthing choice obscenities aimed at the nursing staff and other workers in the nursing home. These are the telltale signs of withdrawal from dangerous opioids such as painkillers. I let Mrs. Smith rant for some time and introduce myself calmly, “I am Dr. Chatterjee and I was asked to see you by the nursing home staff to see how we can help you with the management of your pain during your stay here.”
Opioid addiction in the elderly is on the rise in the United States. A recent report by the Agency for Healthcare Quality and Research (AHRQ) pointed to some alarming facts about opioid use among the elderly. Some of the findings indicate that nearly 125,000 hospitalizations among older Americans involved opioid-related diagnoses in 2015. Also, between 2015 and 2016, nearly four million seniors filled four or more opioid prescriptions, and nearly 10 million filled at least one opioid prescription in those years. Additional reports indicate that opioid-related hospitalizations increased more than 50 percent and opioid-related emergency department (ED) visits more than doubled between 2010 and 2015. In 2015 alone, 124,300 hospitalizations and 36,200 ED visits occurred due to complications resulting from opioid use. These alarming statistics clearly indicate that opioid use among the elderly is rising to epidemic proportions in the United States.
In my opinion, some of the causes of this impending crisis among the elderly are loneliness and comorbid mental health-related issues related to aging. We are an aging nation, and yet we lack the resources to manage our aging population. There is a huge shortage of skilled nursing facilities specialized in dealing with seniors and their mental health illnesses, especially addictions. There is also a shortage of good quality behavioral providers and support staff who can manage these patients and their needs. We need to remedy these deficiencies if we are going to tackle this epidemic on our shores. If we are to save more Mrs. Smiths, we need all the help we can get from our already burdened care providers.
And lastly a word of advice to all my readers – be kind to the nurse or doctor next time you see them. They are working their hinds off for you every day. Trust me. I know. I am one of them!
Dr. Deepan Chatterjee is Health Editor