Yaşlılarda Alkol ve Madde Kullanım Bozuklukları
Özet
Yaşlı popülasyonda alkol ve madde kullanım bozukluklarına (AMKB) yönelik farkındalık tüm dünyada ve ülkemizde yetersizdir. "Bebek patlaması" kuşağının yaşlanmasıyla birlikte son on yılda geriatrik popülasyonda alkol, tütün, esrar ve reçeteli ilaçların kötüye kullanım oranlarında ciddi bir artış gözlenmiştir. Yaşlılar; karaciğer ve böbrek metabolizmasındaki yavaşlama gibi fizyolojik değişikliklerin yanı sıra yalnızlık, kronik ağrılar, tıbbi hastalıklar ve çoklu ilaç kullanımı gibi risk faktörleri nedeniyle maddenin zararlı etkilerine daha açıktır. Gençlerle aynı miktarda alkol tüketildiğinde dahi yaşlılarda daha yüksek kan alkol düzeyleri ölçülmekte; bu durum denge kaybı, düşme, kırık ve bilişsel bozulma gibi olumsuz klinik sonuçları beraberinde getirmektedir. DSM-5 tanı kriterlerinin yaşlılarda uygulanması; bilişsel bozukluklar, işlevsellikteki sinsi değişimler ve tolerans gelişiminin azlığı nedeniyle güçleşmektedir. Tedavide farmakolojik ajanların (akamprosat, naltrekson, buprenorfin vb.) yanı sıra yaşa göre uyarlanmış bilişsel davranışçı terapiler, motivasyonel görüşmeler ve destekleyici yaklaşımlar öne çıkmaktadır. Yaşlıların tedaviye daha iyi yanıt verdiği bilinse de damgalanma ve utanç gibi sosyal engeller tedavi arayışını kısıtlamaktadır. Bu nedenle, geriatrik tedavi prensipleri çerçevesinde risk faktörlerinin iyi değerlendirilmesi ve erken müdahale stratejilerinin uygulanması büyük önem taşımaktadır.
Awareness and research regarding alcohol and substance use disorders (ASUD) in the elderly are insufficient worldwide and in our country. With the aging of the "baby boomer" generation, a significant increase has been observed in the rates of alcohol, tobacco, cannabis, and prescription drug misuse within the geriatric population over the last decade. Due to physiological changes such as slowed liver and kidney metabolism, as well as risk factors including loneliness, chronic pain, medical comorbidities, and polypharmacy, older adults are more vulnerable to the harmful effects of substance use than other age groups. Even when consuming the same amount of alcohol as younger adults, higher blood alcohol levels are measured in the elderly, leading to adverse clinical outcomes such as loss of balance, falls, fractures, and cognitive impairment. The application of DSM-5 diagnostic criteria to older adults is complicated by cognitive deficits, masked declines in functionality, and a lower presentation of tolerance. In addition to pharmacological agents (acamprosate, naltrexone, buprenorphine, etc.) in treatment, age-tailored cognitive-behavioral therapies, motivational interviewing, and supportive approaches stand out. Although it is known that older adults respond better to treatment, social barriers such as stigmatization and shame limit their treatment-seeking behavior. Therefore, within the framework of geriatric treatment principles, a thorough evaluation of risk factors and the implementation of prevention strategies are of paramount importance.
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