Complications of Aging and Substance Abuse

Complications of Aging

• Rate and effects of aging vary among individuals, depending on:
  • Genetic makeup
  • Lifestyle
  • Health status
  • Cardiovascular fitness
• General reduction in function occurs throughout the body.
• Most vulnerable tissues:
  • CNS
  • Skeletal muscle
  • Cardiac muscle
  • Kidney

Skin and Mucosa

• Skin and mucus membranes:
  • Become dry and thin due to a decrease in subcutaneous tissue.
  • Become more easily damaged.
  • Wrinkles occur because elastic fibers are reduced, and collagen is less flexible.
  • Increase in lesions.
• Hair grays due to reduced melanocytes; hair thins due to a reduced number of hair follicles.

Cardiovascular

• Reduced strength of contractions.
• Size and number of cardiac muscle fibers decrease.
• Heart valves thicken and lose flexibility.
• Arteriosclerosis: degeneration of small arteries (hardening of the walls and narrowing of the lumen), causing decreased blood flow.
• Atherosclerosis: development of lipid plaques and thrombi causing obstruction.

Musculoskeletal

• Osteoporosis: loss of calcium and bone mass, increasing the risk of fractures.
• Osteoarthritis: degeneration of cartilage in joints, related to aging, trauma, or sports injuries.
• Flexibility, coordination, and balance are reduced.
• Decrease in the strength of muscle contractions.

Respiratory

• Ventilation is limited due to a reduction in lung elasticity and weakened intercostal muscles.
• Decreased expansion for deep breathing and coughing.
• Heart valves thicken and lose flexibility.
• Decreased perfusion and reduced gas exchange in alveoli.

Nervous System

• Reduction in brain mass.
• Accumulation of lipids and tangles.
• Decreased response to neurotransmitters.
• Slower response time and decreased reflexes.
• Decrease in short-term memory.

Changes in Sensation

• Vision
  • Lens becomes less flexible and less transparent, leading to reduced accommodation.
  • Development of cataracts.
  • Decrease in night vision and color vision.
• Hearing
  • Hearing loss due to degenerative changes or trauma.
• Smell/Taste
  • Decreased sense of smell and taste, which may impair appetite and nutrition.

Gastrointestinal System

• Nutrition affected by lack of money, ability to cook, and decrease in smell and taste.
• Obesity is common in older people, leading to hypertension (HTN), atherosclerosis, and diabetes mellitus type 2 (DM 2).
• Increased cardiac workload.
• Reduced digestive secretions and impaired absorption of vitamins/minerals.
• Constipation.

Urinary System

• Reduction in kidney function.
• Loss of nephrons.
• Diminished response to adapt to changes in electrolyte and acid levels.
• Reduced capacity to excrete drugs.
• Weakened urinary sphincter and bladder.
• Nocturia: frequent urination at night.
• Incontinence.

Immune System

• Immune system declines.
• Decreased ability to fight infections.
• Higher cumulative exposure to carcinogens.
• Increase in autoimmune disorders.

Multiple Disorders

• Changes in one system often cause a cascade of other problems.
• Integrated treatment is necessary.
• Polypharmacy: use of a large number of medications, including prescription, herbal, and over-the-counter drugs.
  • Increased risk of interactions.
  • Compliance may be an issue.
  • Unpredictable absorption, distribution, and elimination of drugs; dosages may need adjustment.

Substance Abuse

• Substance abuse or chemical dependency leads to:
  • Changes in behavior.
  • Changes in sleep patterns.
  • Changes in interpersonal relationships.
  • Problems with employment.
  • Serious health problems.
  • Possibly even death.

Definitions in Substance Use Disorders

• Physiological dependence:
  • Discontinuance of substance leads to withdrawal.
• Psychological dependence:
  • Continuing desire to take the substance to function.
• Tolerance:
  • Body has adapted to the substance.
  • More must be taken to achieve the same effect.
• Addiction:
  • A compulsive or chronic requirement.

Drug Classifications

• Central nervous system (CNS) depressants -> respiratory depression
  • Sedatives, antianxiety agents, alcohol, cannabis
• Narcotics (also CNS depressants -> respiratory depression)
  • Painkillers: Opioids
• Stimulants -> can lead to aggression
  • Coffee, nicotine
  • Amphetamines, cocaine
• Psychedelics -> can lead to psychosis
  • Hallucinogens (LSD, Peyote, Psilocybin)
• Examples of Opioids:
  • OPIUM
  • MORPHINE
  • FENTANYL
  • OXYCODONE
  • HYDROCODONE
  • HYDROMORPHONE
  • METHADONE
  • HEROIN

Sources and Risk Factors

• Sources
  • Prescribed medications
  • Readily available: Alcohol, decongestants, glue, solvents
  • Illegal or street drugs
• Risk Factors
  • Heredity and/or genetics
  • Family systems and practices
  • Disease
  • Increased availability of drugs
  • Stress
  • Increased medical use of mood-altering and analgesic agents
  • Acceptance of alcohol or marijuana as a recreational tool in all age groups

Complications of Substance Abuse

• Overdose:
  • Street drugs may be contaminated/unknown dosage.
• Withdrawal:
  • Due to physiological dependency: Irritability, tremors, nausea/vomiting, HTN, psychotic behavior, convulsions.
• Effects on pregnancy:
  • No prenatal care, directly affects the fetus.
• Cardiovascular problems:
  • Stimulants: HTN, MI, Strokes.
• Infection:
  • Due to malnutrition, injection sites, shared needles (Hep C).
• Neurological/psychological effects:
  • Memory impairment, poor judgement, high-risk behavior, psychosis, depression, anxiety, suicide.
• Alcohol:
  • Cirrhosis.
  • Nervous system damage- Wernicke-Karsakoff Syndrome (\downarrow thiamine and folic acid).

Treatment

• Overdose or toxic effect:
  • Treat immediately in the emergency room.
• Withdrawal:
  • Should be handled in a medical facility.
• Supportive care:
  • Required to prevent complications.
• Therapy:
  • Counseling and behavior modifications.
• Support groups:
  • e.g., AA (Alcoholics Anonymous).