2017, Kesihatan

Older people and substance abuse

Eve Sonary Heng, reporters@theborneopost.com

Substance abuse among the elderly is one of the fastest growing health problems in many countries, including Malaysia.

 

WHENEVER ‘drug addicts’ or ‘substance abusers’ are mentioned, what usually spring to mind are images of young people high on drugs (or whatever illicit substances), wasting away their lives at some godforsaken place.

These images of bleakness are heart-wrenching. But there is another equally, but less obvious, sad scenario — substance abuse among the elderly, one of the fastest growing health problems in many countries. And Malaysia is not spared.

Generally, older people are considered mature enough to know what is right and wrong and as such, will not fall victim to substance abuse but that is beside the point.

In society, there are always people who fail to make a proper life for themselves or may have health problems not identified and treated, and thus, would end up destitute, unwanted and ignored. They are the most vulnerable groups who would resort to substance abuse to escape the harsh realities of life.

Substance abuse among senior citizens is sometimes referred to as a ‘hidden epidemic’.

According to consultant psychiatrist and addiction medicine specialist Professor Dr Philip George, who is also Malaysian Healthy Ageing Society (MHAS) president, the elderly casualties of such misery have been found to abuse all types of substance, the most common being alcohol, nicotine and some prescription drugs such as Benzodiazepine.

Benzodiazepines, sometimes called benzos, are a class psychoactive drugs whose core chemical structure is the fusion of a benzene ring and a diazepine ring. They are used to treat insomnia, panic attacks, seizures, restless leg syndrome and alcohol withdrawal.

Dr Philip defines substance abuse as chronic or habitual use of any chemical substance to alter sates of body or mind other than for medically warranted purposes.

Even though the percentage of substance abuse among older people was still small, the situation could be considered serious and should not be ignored, he said after presenting a topic on Substance Abuse Among The Elderly at the Healthy Ageing Conference held in collaboration with the Sarawak Convention Bureau.

He revealed the heaviest substance abusers are people over 55 years old.

Alcohol abuse

Touching on alcohol abuse, he said it is a disorder, characterised by the excessive consumption of alcoholic products to the point of being addicted or dependent on it, thereby leading to physical and psychological harm.

“Addicts may also become a nuisance or a danger to others, or they may create family problems or jeopardise their own careers.”

According to him, the prevalence of heavy drinking — 12 to 21 drinks per week — in older adults is estimated at three to nine per cent.

As far as he has discovered or been made to understand, there are a number of reasons why elderly people turn to alcohol or drugs. Among the more common ones are being poor, living alone without any relatives or friends to socialise with, having encountered some form of losses recently or been ill for a while because of a progressive or chronic ailment.

There have also been some cases where a head injury has caused a change of mental attitude and behaviour in elderly people. To make matters worse, their excessive alcohol consumption would further jeopardise the functions of their brain.

Cases of seniors abusing alcohol or drugs tend to go undetected.

Dr Philip said those living alone would find it easier to hide their substance abuse while for those already mentally ill, turning to alcohol or drugs would damage their brain even more apart from affecting the well-being of the whole body.

He pointed out that older people were far more likely to suffer physical and mental damage as a result of alcohol or drug abuse, adding: “That’s because their body is less able to defend itself against such over-indulgence and this can mean their health will rapidly decline.”

Dr Philip further explained in older people, alcohol, for instance, could do a lot more damage to their health owing to reduced production of liver enzymes to deal with the intake of alcohol.

“Then there’s also a change in the fat-to-water body ratio which means there is less water in the body to dilute the amount of alcohol present.

“Also, tolerance levels for alcohol and drugs decrease with age. This means they can experience increasingly negative effects even when they are only using these substances at the same level as in the past.”

Substance abuse symptoms

According to Dr Philip, the symptoms of substance abuse among the elderly include manifesting some secretive behavior, very poor in remembering recent incidents, getting irritated easily when asked about their alcohol and drug use, loss of appetite, drastic mood changes when a bit high on the substance used, inability to concentrate, withdrawal from social life and exhibiting depression or irrational behaviour.

Symptoms which can be considered as already showing signs of alcohol abuse are a constant increase over time in the amount or frequency in the abusers’ alcohol consumption, their increased tolerance to the effects of alcohol, confusion, disorientation, blurred vision, gastrointestinal problems (nausea, vomiting), insomnia, unusual drowsiness, lack of physical coordination, malnutrition, slurred speech, urinary problems (incontinence, retention) and withdrawal symptoms like nausea, headache, anxiety, depression, sleeplessness even when less than the usual amount is consumed.

He said the National Institute of Alcohol Abuse and Alcoholism (NIAAA) recommends that alcohol consumption for adults, aged 65 and older, be limited to one standard drink (300ml of normal beer, 60ml of wine or 30ml of spirits) per day or seven standard drinks per week and no more than three drinks on one occasion.

As for benzodiazephines abuse symptoms, he said they included drowsiness, confusion, blurred vision, weakness, slurred speech, lack of coordination, difficulty in breathing, and coma.

At normal or regular doses, benzodiazepines relieve anxiety and insomnia.

He pointed out that despite their many helpful legitimate uses, benzodiazepines, when not consumed as prescribed, could lead to physical and psychological dependence on the drug, and if the abusers were made to stop taking the drug abruptly, they would display withdrawal symptoms like getting seizures or falling into a state of delirium.

Mental health problems

Dr Philip said certain underlying mental health problems could cause the elderly to resort to substance abuse, adding that they had a misconception they could use these substances to self-medicate.

He noted that about half of the individuals with severe mental health problems were also substance abusers.

“The causes include depression due to the many losses they have suffered upon getting old. For instance, they may have lost their energy and physical capability or their spouses or friends. Or they may be suffering from the side effects of the medication they are taking. Any one of these can drive them into depression and to use alcohol or drug to try and cope.”

He said it was important for them to know expert assessment of their condition and certain treatment could help them but unfortunately, many of these elderly people were also aware their image may be tarnished with a social stigma if they sought treatment, causing them to shun professional help.

Intervention

According to Dr Philip, diagnosis of substance abuse symptoms among the elderly may be more tricky because the symptoms sometimes mimic those of other medical and behavioural disorders common among older people, especially depression or dementia.

“Another factor which makes the phenomenon of substance abuse very elusive and not easily detected is that the abusers consider their habit as a private affair and refuse to seek professional intervention.

“It is, therefore, important that primary care doctors and nurses understand the need to get assessments done to identify those who may have been substance abusers, and work out some plan of intervention for them.

“If sufficient knowledge and research data are made available, healthcare providers can then work out bigger plans to ensure this elderly group of people can receive the needed treatment.”

He stressed that people should not just leave it to healthcare personnel to detect substance abuse among the elderly.

Friends, family members, caregivers or anyone else more intimately acquainted with the habits and daily routines of the persons concerned were very often the people in the best position to detect those behavioral changes that signalled a possible problem, he said.

Dr Philip listed some of the intervention efforts that could help elderly substance abuse victims:

l Age-specific group treatment that is supportive, not confrontative.

l Attend to depression, loneliness; address losses.

l Teach skills to rebuild social support network.

l Employ staff experienced in working with the elderly.

l Link with ageing, medical institutional settings.

l Content should be age-appropriate and offered at a slower pace.

l Create a ‘culture of respect’ for older patients.

l Broad, holistic approach recognising age-specific psychological, social and health aspects.

l Adapt treatment as needed to address gender issues.

Substance abuse in Australia

Another speaker, Dr Sadhana Maharaj, a consultant psychiatrist at the Canterbury Community Health Centre in Australia, said substance abuse among older people was also one of the fastest growing health problems in Australia.

She added that people with conditions of chronic pain such as from back injuries, previous traumas or vehicle accidents, tended to abuse the medication they were prescribed with, and since older people were more prone to developing delirium, they would often abuse sleeping tablets.

“Sleep has become a big problem, and often when they go to see a general practitioner (GP) for treatment, the easiest thing to give is sleeping tablets. We’re trying to move away from that now, and to give more natural ingredients of treatment like Melatonin. It’s not as cheap though – in fact, it’s cheaper giving Benzo than Melatonin.”

Melatonin is a natural hormone made by a body’s pineal gland. It is a pea-sized gland just above the middle of the brain. During the day, the pineal is inactive. When the sun goes down and darkness occurs, the pineal is “turned on” by the suprachiasmatic nucleus (SCN) and begins to actively produce melatonin which is released into the blood.

At this point, Dr Philip chipped in to say it was difficult to get natural medicines into Malaysia and even Melatonin is sometimes not available and only certain clinics have the product.

Resuming her dialogue, Dr Sadhana said self-medicating among the elderly was a concern, adding that there was a cohort of people, especially the war veterans, who suffered from post traumatic stress disorder (PTSD) which occurred after they experienced severe trauma or a life-threatening event.

“Even though there are lots of resources as well as psychological support to help them manage their PTSD, they tend to self- medicate. And there is a high rate of substance abuse incidence among them.”

She pointed out that this was largely because of easy access to medication products via the Internet.

“People can order Valium-like and Melatonin-like drugs from overseas and that too leads to dependency. In fact, substance abuse among young Australians is a growing problem. Amphetamines, ice, ecstasy are the common drugs they use.

“The immediate effects from Ice are intense pleasure and clarity. All drugs have the potential for dependency. One major issue we have been facing is they (drug users) seldom use single drugs but usually mix them with something else to enhance the effects which is very damaging to health.”

Medication abuse

Dr Philip said in Malaysia, access to medication via the Internet was also happening but more so among the younger generation.

“The age group largely affected are teenagers and young adults. This is the period of their lives when many have to cope with stress and when they get introduced to drugs and recommended to use them to cope with their stress, they would eventually become habitual users and dependent on the drugs.

“I think among the more effective prevention methods is empowering the youths rather than punishing them. Punishing usually would not stop people from using, but empowering may give them the will power to deal with life’s issues more realistically without resorting to drugs.”

He said in Sabah and Sarawak, amphetamine is a very common drug of substance abuse, while in peninsular Malaysia, the common ones are Heroin and Morphine.

According to him, the most common drug of abuse is cannabis but it is not so noticeable because users usually do not end up committing crimes and that’s why reliable official statistics on cannabis users are not available.

Dr Philip believed it is better to find effective ways to raise awareness among the people that substance abuse is really bad for them in the long run.

Sumber diperolehi daripada Borneo Post Online

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2017, Kesihatan

Radikal Bebas, Penyakit dan Penuaan

Kemajuan dalam bidang perubatan sejak se abad yang lalu telah meningkatkan jangka hayat manusia sebanyak 50%. Pembangunan sistem pembetungan yang maju, air bersih, antibiotik, vaksin dan kebersihan diri telah berjaya menghapuskan kebanyakan penyakit berjangkit. Jangka hayat dapat dipanjangkan dan penyakit akut bukan lagi penyebab kematian utama.

Namun terdapat banyak kematian yang disebabkan oleh penyakit kronik, seperti kanser, lemah jantung dan lain-lain penyakit yang berpunca dari kelemahan dan ketidakfungsian sistem imun. Penyakit-penyakit yang membuat pengidapnya kurang berupaya dan perlu bergantung kepada orang lain. Ketidakupayaan meningkat dalam beberapa tahun terakhir kehidupan, begitu juga dengan penyakit, yang menjadikan kematian satu proses panjang yang mahal dan menyakitkan.

Persoalannya: Apakah yang menyebabkan penuaan dan penambahan penyakit dan ketidakupayaan apabila usia semakin meningkat?

Daripada berbagai teori mengenai penuaan, sehingga kini hanya teori radikal bebas yang diterima ramai. Teori ini mula diketengahkan oleh Professor Denham Harman pada tahun 1954. Ia menyatakan bahawa penuaan disebabkan oleh pengumpulan perubahan dalam badan yang disebabkan oleh molekul reaktif tinggi yang dikenali sebagai radikal bebas.

Dari mana datangnya radikal bebas dan apa kesannya?

Sel badan kita menggunakan oksigen untuk menghasilkan tenaga. Di dalam proses tersebut, kadang-kadang oksigen akan bertindakbalas dengan sebatian badan dan menghasilkan molekul yang sangat tidak stabil. Molekul ini dikenali sebagai radikal bebas. Selain dari proses biasa badan kita, faktor alam sekitar seperti pencemaran udara, asap rokok, radiasi, bahan kimia dan lain-lainnya akan menambahkan lagi pembentukan radikal bebas. Masalah akan timbul apabila jumlah radikal bebas melebihi daripada yang mampu dihapuskan oleh sistem badan. Keadaan dikenali sebagai stres oksidatif.

Radikal bebas adalah molekul yang elektronnya tidak mempunyai pasangan. Ini membuat ia menjadi tidak stabil dan tersangat reaktif. Untuk kembali stabil, radikal bebas akan segera merampas elektron dari sebatian yang stabil tetapi lemah pertahanannya. Sebatian tersebut adalah sel badan kita. Pencerobohan ini merosakkan sel, merubah fungsi dan juga DNAnya. Kerosakan ini melibatkan semua sel baru yang mewarisi DNA tersebut. Semakin usia meningkat semakin bertambahlah sel badan yang rosak, justeru semakin banyaklah fungsi semula- jadi badan yang tergendala dan ianya mengundang berbagai masalah kesihatan.

Kajian-kajian yang dijalankan di zaman moden ini telah menemui pertalian antara stres oksidatif dengan lebih dari 200 jenis penyakit. Antaranya kanser, arthritis, kencing manis, penyakit buah pinggang, penyakit Alzheimer, penyakit Parkinson, buta akibat usia dan lain-lain penyakit degeneratif.

Bagaimana hendak tangani radikal bebas?

Badan kita memerlukan antioksidan untuk memusnahkan radikal bebas. Namun begitu badan kita tidak mengeluarkan anti-oksidan, ia bergantung kepada bekalan yang diperolehi dari makanan kita. Seperti yang telah diketahui ramai, anti-oksidan boleh diperolehi dari Vitamin C, Vitamin E dan beta karotina.

Kajian-kajian yang dijalankan oleh beberapa institusi mendapati bahawa sumber terbaik antioksidan boleh diperolehi dari sejenis buah beri yang dinamakan Acai. Ia mengandungi 33 kali lebih banyak anti-oksidan jika dibandingkan dengan anggur merah. Beri Acai telah dinobatkan sebagai salah satu dari “10 makanan hebat untuk menentang penuaan” di dalam rancangan Oprah Winfrey.

Terdapat beberapa produk pemakanan tambahan yang menggunakan beri Acai sebagai bahan utamanya. Ia digabungkan dengan beberapa buah-buahan lain yang mengandungi kandungan anti-oksidan yang tinggi dan ditambah dengan bahan-bahan lain untuk memperbaiki sistem badan yang telah rosak akibat serangan radikal bebas.

“CEGAH APA YANG BOLEH DICEGAH DAN LAMBATKAN APA YANG TIDAK BOLEH DIELAKKAN.”

Sumber diperolehi daripada http://www.kesihatan.biz

2017, Kesihatan

Pelat masalah artikulasi perlu diberi perhatian

Artikel oleh Mariatul Qatiah Zakaria

“JANGAN terlalu melayan pelat anak-anak sehinggakan kita sebagai ibu bapa turut bercakap pelat dengan mereka. Malah ibu bapa seharusnya memperbetul pelat anak dan bukannya memarahi kerana dikhuatiri anak-anak ini akan berasa bimbang, cemas, takut, dan malu.” Itu antara nasihat Pakar Kanak-Kanak, Pusat Perubatan Pakar Sri Kota, Dr. Diana Osman ketika diminta mengulas mengenai permasalahan pelat dalam kalangan kanak-kanak.

Menurut Dr. Diana, pelat pertuturan merupakan masalah yang terjadi pada artikulasi atau kesalahan pada sebutan yang lazimnya berlaku pada umur tertentu dan turut melibatkan pola bunyi.

Tambahnya, bagaimanapun masalah ini akan berhenti selepas kanak-kanak berkenaan mencapai umur tertentu dan akan semakin mahir dalam sebutan harian.

Dr. Diana memberitahu, ibu bapa yang berhadapan dengan masalah anak pelat seharusnya mengetahui adakah anak-anak mereka hanya bermasalah pada pertuturan atau bahasa sahaja.

Ini kerana secara purata, kanak-kanak pelat, artikulasinya akan mula menunjukkan kemajuan atau memahirkan sebutan selepas lima tahun.

Selepas umur tersebut, sekiranya anak-anak mereka masih pelat, ibu bapa dinasihatkan merujuk mereka kepada pakar terapi pertuturan kerana dikhuatiri mengalami masalah kelewatan perkembangan yang melibatkan aspek-aspek tertentu seperti penggunaan ucapan dan bahasa yang salah serta kekurangan dari segi kemahiran bersosial.

Jelas Dr. Diana, lazimnya, pihaknya akan memberi tempoh sehingga anak-anak pelat ini berumur tujuh tahun untuk artikulasinya normal seperti kanak-kanak lain sebelum dirujuk kepada pakar terapi pertuturan.

Dia memberitahu, selalunya pada usia tiga tahun, kanak-kanak sudah boleh menyebut huruf-huruf P, M, H, W dan B yang merupakan julat umur kanak-kanak ketika sudah mampu bertutur.

Begitupun, ada kanak-kanak yang akan bermula dengan huruf-huruf tertentu untuk dikuasai, tetapi Dr. Diana menekankan, bagi huruf R, lazimnya kanak-kanak memang bermasalah untuk menyebutnya.

“Untuk pengetahuan bersama, huruf-huruf seperti R dan V, kanak-kanak memerlukan koordinasi lidah untuk menyebut dan kedua-dua huruf ini akan mengambil masa bagi golongan ini untuk menuturnya.

“Begitu juga dengan K di mana huruf ini merupakan huruf yang biasa ‘dipelatkan’ dalam sebutan dan kanak-kanak akan mengggantikan huruf ini dengan huruf T.

“Hal ini dilihat berkait rapat dengan perkembangan otot dan ia berlaku selaras dengan umur, di mana semakin meningkat umur kanak-kanak, otot-otot lain pada diri mereka akan lebih berfungsi,” ujarnya.

Dr. Diana menekankan, sebutan pelat bukanlah satu kecacatan dan juga bukanlah disebabkan faktor keturunan atau pun genetik.

Tetapi boleh dikategorikan sebagai cacat sekiranya disusuli dengan kecacatan fizikal lain seperti sumbing lelangit, sumbing bibir atau pun lidah pendek.

Namun begitu sekiranya kecacatan fizikal ini ‘diperbaiki’, secara tidak langsung dapat menyelesaikan masalah pelat yang dialami kanak-kanak.

“Ibu bapa juga seharusnya memberikan perhatian kepada perkembangan pertuturan anak masing-masing kerana adakalanya anak-anak pelat turut mempunyai masalah pendengaran.

“Pertuturan pelat akan berlaku sekiranya kanak-kanak ini tidak boleh mendengar dengan baik yang akan memberi kesan kepada pertuturan.

“Lazimnya kanak-kanak yang mempunyai masalah pendengaran adalah disebabkan mereka kerap terkena jangkitan pada telinga,” jelasnya.

Oleh itu nasihat Dr. Diana, ibu bapa disarankan agar jangan membiasakan dengan tabiat mengajuk percakapan anak-anak, sebaliknya bercakaplah dengan bahasa yang lengkap seperti mana kita bercakap dengan orang dewasa lebih-lebih lagi apabila si kecil dilihat sudah mula memahami lenggok percakapan.

Dalam kajian juga, pakar menemukan beberapa alasan mengapa seorang dewasa perlu bercakap dengan jelas dan bukannya dengan ‘bahasa anak kecil’ apabila berkomunikasi dengan mereka, antaranya ialah agar anak-anak ini dapat bertutur dengan lancar dan memahami apa yang disebut.

Ibu bapa juga mesti segera bertindak sebaik saja mengesyaki anak mereka mengalami masalah pertuturan kerana ia mungkin petanda kepada masalah lain yang lebih serius seperti pendengaran, autisme atau masalah tumpuan.

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