BY PARADISE AFSHAR
SPECIAL TO THE MIAMI HERALD
APRIL 24, 2015 08:00 AM, UPDATED APRIL 24, 2015 04:00 PM
Think older adults are just sitting around and watching TV?
Not always so. They may be engaging in risky behaviors that can impact their physical and emotional health and finances. The four biggest concerns, experts say: unprotected sex, gambling, binge drinking and misusing drugs.
Gambling among seniors is on the rise, said Dr. Regina Marranzini, medical director of the Acute Care for Elders Unit at Memorial Regional Hospital in Hollywood.
Gambling is the most frequently identified social activity among adults 65 years and older, according to the National Council on Problem Gambling Seniors. For those on a fixed income, gambling may leave the person with less money to spend on medical treatments.
“Their finances, which are already limited, are being used up,” Marranzini said. “So later if they need a home health aide or long-term care, those things are not normally covered by Medicare or most insurances, and must come out of pocket.”
Marranzini said she frequently sees patients who break a hip or other body parts after taking a fall while gambling — and for seniors one fall can be deadly. One in five people who have had a hip fracture die within a year of their injury due to complications after the fall, according to the Centers for Disease Control and Prevention. Injuries such as lacerations, hip fractures and head traumas occur in 20 to 30 percent of people who fall.
Excessive gambling can sometimes be a sign of a neurological problem that may not be detected.
Dr. Elizabeth Crocco, chief of the division of geriatric psychiatry at the University of Miami Miller School of Medicine, explains that atypical behavior — like when a person who has never gambled takes up the activity — can be a sign of Alzheimer’s, dementia or other neurological disorders.
In addition, changes in behavior can be attributed to certain medications.
“Patients who have Parkinson’s and take a medication called L-dopa can have an increased chance of risky behavior, like gambling,” Crocco said. “That’s why if somebody has a big change, it’s usually a sign that they need to see a doctor.”
The CDC lists binge drinking among older adults as a key concern.
While overall binge drinking is more common among 18- to 24-year-olds, seniors are reported to binge drink more often than their younger counterparts — an average of five to six times a month. When seniors do binge drink, they consume an average of six drinks, according to the CDC.
Drinking in excess can put a person at risk for developing high blood pressure, liver disease, certain cancers, heart disease, stroke and other medical conditions, the CDC says. Binge drinking can also increase a person’s risk of getting into a car crash or falling.
Part of the reason for these effects is the way the body processes alcohol as you age.
“When you get older, it takes less alcohol to affect you in a negative way,” Crocco said. “As an older person, your body, physiologically, has changed.”
In addition, certain medicines can have dangerous or even deadly side effects if mixed with alcohol.
The National Institute on Aging, a division of the National Institutes of Health, warns that the mix of aspirin and alcohol can increase the risk of stomach or intestinal bleeding. Additionally, combining alcohol with some sleeping pills, pain pills or anxiety/anti-depression medicines can be deadly.
When it comes to sexually transmitted diseases, the CDC reports that older Americans are often uncomfortable discussing sexual behaviors or condom use with their physicians and partners.
“Part of the problem is that we as the medical community have failed to educate the elderly on safe sex,” said Marranzini, who is working on a book about seniors and sex titled, Sex After 69. “This is a generation that didn’t grow up receiving any information on safe sex. You have a lot of older adults who’ll say, ‘Well, I can’t get pregnant anymore, there is no use in using contraception.’ ”
The CDC reports that STDs vary by age group and geography, and for those 65 and older, the rates of chlamydia, gonorrhea and syphilis remain relatively stable.
When it comes to HIV, the CDC reports that a growing number of people over 50 are living with HIV — about 26 percent of the estimated 1.2 million people living with HIV in the United States are 55 years or older. Older adults are more likely to be diagnosed with HIV later in the disease.
Marranzini said she’ll see patients who have had STDs such as herpes for decades and never knew they were carrying it. This can be dangerous because if left untreated, STDs can be passed onto other people and can cause serious problems. Latent stages of syphilis, for example, can result in dementia.
In recent years erectile dysfunction drugs such as Viagra have made it easier for seniors to have sex.
“You see this boom in sex among the elderly, but there is not a boom is educating the elderly about sex,” Marranzini said. “Usually STDs in older people are either missed or misdiagnosed.”
She says part of the problem is that some physicians don’t always ask their patients the proper questions about their sex lives.
“Doctors need to ask, ‘Are you having sex?’ ” said Marranzini, adding that the follow-up question to a yes reply should be, “ ‘Are you having safe sex?’ This needs to start in medical school training.”
Adults 65 and older account for more than one-third of outpatient spending on prescription medications in the United States, according to the National Institute on Drug Abuse.
The CDC reports that 37 percent of older adults take five or more medications. The combination of taking prescriptions long term and taking several medications at once can have dire consequences and lead to misuse.
Dr. Joel Danisi, an assistant professor of clinical gerontology at the University of Miami Miller School of Medicine, said there are several reasons why a patient may not take their medicine correctly: They feel they won’t benefit from the medication, instructions are not clear, or they fear they’ll become addicted.
The National Institute on Drug Abuse reports that some seniors experience a cognitive decline, which can lead to improperly taking their medications.
“Someone who doesn’t know if they took their medicine can take double or triple the [proper] amount and accidentally overdose,” said David Vittoria, assistant vice president of the South Miami Hospital Addiction Treatment & Recovery Center.
One factor that can lead to misuse is that different doctors prescribe medications without realizing what other drugs the patient is taking. Vittoria recommends that seniors carry with them an updated list of their prescriptions to show the doctor before other medications are prescribed.
While drug abuse can occur in older adults, it may go undetected in seniors as signs of abuse are sometimes attributed to aging. And it’s not just prescription medications that older adults are using.
“You’ll see baby boomers using drugs,” said Crocco, particularly marijuana. “They are more likely to use them because they used them when they were young.”
The South Miami Hospital Addiction Treatment & Recovery Center
Phone: 1-800-Yes-Hope (937-4673); Website: www.baptisthealth.net/addictiontreatment
Memorial Regional Hospital: Acute Care for Elders Unit
Phone: (954) 265-4750; Website: www.MHS.Net
Address: 3501 Johnson St, Hollywood 33021
Center on Aging at the University of Miami Miller School of Medicine
Phone: 305-355-9080; Website: www.centeronaging.med.miami.edu/