Seniors, SAD and Opioid Dependency

At least 91 Americans will lose their lives to opioids today.

Some will be young, but others may be seniors too.

The opioid epidemic does not discriminate. It impacts young adults, adolescents, children, those in middle age and seniors. While the effects ricochet across all age groups, the epidemic poses a serious risk to seniors. Seniors are already susceptible to major depression, illness, and the need for post-acute care (PAC) services. As revealed by the Healthcare Cost and Utilization Project (H-CUP),  opioid overdose and rehospitalization statistics among seniors show no signs of slowing.

Decreasing daylight hours during fall, the upcoming holidays and the continued devastation of the opioid epidemic create the perfect storm for seniors. These conditions are conducive to the development of seasonal affective disorder (SAD). Meanwhile, seniors struggling with seasonal affective disorder may turn to opioids to feel better, but this exacerbates the problem.

To help seniors receiving care from Health and Human Services (HHS) organizations, post-acute care providers or other caregivers, your organization needs to understand the deadly triad of seniors, opioid abuse and SAD.

What Exactly Is SAD?

SAD is a form of depression related changes in light levels, explains the National Institute of Mental Health (NIMH). When individuals are diagnosed with SAD, they meet all of the symptoms of major depression, but it occurs in a specific season and recurs over at least a two-year period. Seasonal depression may also be more frequent than non-seasonal depression.

The primary symptoms of SAD mirror the symptoms of major depression, which include the following:

• Feelings of worthlessness or hopelessness.
• Experiencing fatigue or consistent low-energy.
• Changes in sleep patterns.
• Changes in appetite or weight.
• Having trouble concentrating.
• Irritability and being easily agitated.
• Feeling depressed or sad.
• Loss of interest in once-enjoyed activities.

For individuals and seniors suffering from fall- and winter-related SAD, expression of major depressive symptoms includes the following:

• Overeating.
• Weight gain.
• Craving for carbohydrates.
• Social withdrawal.
• Having low-energy.

What Do SAD Symptoms Mean for Opioid Abuse Among Seniors Receiving Post-Acute Care?

Younger adults have the greatest risk for developing SAD, but SAD symptoms occur in seniors too. Consider how the primary expressions of SAD impact seniors.

Overeating may complicate medication regimens, and sleeping too much can result in the formation of pressure ulcers due to little or no movement while in bed. Introduce opioids to the mix, and the symptoms of SAD increase. Opioids increase tiredness and suppress body systems, and withdrawal may result in intense pain, among other symptoms.

How Can SAD and Opioids Increase Risk to Seniors?

Put overdose risk aside for a moment, and focus on falls.

Confusion, sudden changes in blood pressure, muscle weakness, problems with gait and balance and prescription medications increase risk for falls, explains the National Institute on Aging (NIA). Euphoria, dizziness and confusion are also some opioids, which further increase fall risk.

In fact, falls are the primary cause of injury and death in older Americans, so abusing opioids directly contributes to an increased mortality rate, reports the Centers for Disease Control and Prevention (CDC).

Now, seniors experiencing the symptoms of SAD have an even greater threat, falls paired with prescription opioids. If the fall results in a surgical procedure in the need for PAC, a senior may be prescribed opioids for pain management. However, physicians slow to adopt recent CDC recommendations for prescribing guidelines may dispense an extensive prescription for seniors in this category.

A senior suffering from a fall may transition from chronic pain management to opiate abuse. In addition, the H-CUP findings suggest major medical events, such as a fall resulting in fracture or severe injury, contribute to the quintupled opioid abuse and overdose rates among seniors. The cycle becomes self-fulfilling, and seniors taking opioids following a fall further increase fall risk.

The feelings associated with SAD may also increase this risk, so breaking seniors free from this danger is essential to ensuring effective and quality post-acute care.

How Does Senior Living Arrangement Impact SAD and Opioid Risk?

Seniors and individuals living alone or in health care facilities may be more likely to suffer from SAD. Paired with the opioid epidemic, seniors falling into this group may be two or three times more likely to suffer a major health event, including stroke, heart attack, fall or even opioid overdose. It is also important to consider seniors may overdose on opiates do to H-related memory loss.

Senior may forget he or she previously taken medications, and the resulting euphoric state can transform opiates for pain management to opioid addiction over time.

Even seniors living in supervised facilities or receiving supervised care visits at home may suffer from sad. If family members do not visit, depressive symptoms may arise. If an injury occurs, fatigue, tiredness and desire to feel better may lead to poor decisions when taking prescription medications.

It sounds like a nightmare, and it is just that. While family members get together for the holidays, seniors experiencing the symptoms of SAD may further withdraw, and the cycle grows tighter.

What Can Your Organization Do to Help Prevent SAD and Opioid Abuse Among Seniors?

There are a few steps your organization can take to help prevent the tragedy of opioid abuse among senior suffering from SAD. These steps include the following:

• Know the symptoms of SAD. Any instance of seniors experiencing symptoms should be reviewed with his or her primary care physician (PCP). Caregivers, HHS workers and other health care professionals should stay vigilant for the symptoms.
• Help seniors manage their medications. Seniors who understand what medications should be taken properly are less likely to accidentally overdose, found a longitudinal study, reports the Journal of Affective Disorders. Furthermore, seniors experiencing depressive symptoms and taking opioids simultaneously for pain management were more likely to stop taking opioids.
• Encourage non-opioid means of managing pain. This includes encouraging healthcare providers and professionals to utilize non-prescription pain management tactics, such as yoga, meditation, or physical therapy.
• Spend time with those you serve. You cannot order the family members and friends of those you serve to spend time with them, but your caregivers can take on this responsibility. Encourage caregivers to communicate fully and ask about seniors’ feelings. The simple act of having a conversation with seniors could be key to reducing isolationism and the symptoms of SAD.
• Consider adding vitamin D and light therapy to care regimens. Light therapy and vitamin D are believed to help alleviate the symptoms of SAD. However, it may be difficult to encourage light therapy among seniors. Instead, encourage seniors to spend as much time outdoors, weather permitting, as the seasons change. In addition, ensure those in your care take either a vitamin D supplement or drink vitamin D milk.

What Else?

No one should have to feel the weight of SAD, and the growing opioid epidemic is only likely to make prevalence of SAD worse. By understanding more about this disorder and opioid abuse among seniors, you can raise awareness in your community, and your organization can be key to helping those struggling with opioid addiction and SAD symptoms receive the treatment they need.

Failure to do so will result in the worsening of health conditions and the need for additional, more intense acute services, if not death following an overdose.