By Liz Seegert
Some one million adults aged 65 and older currently live with a substance use disorder (SUD), according to the Substance Abuse and Mental Health Services Administration (SAMHSA). While use of illicit drugs in older adults is much lower than among other adults, it’s on the rise. In the United States, the number of older adults needing treatment for substance use has tripled since 2000 — from 1.7 million to 5.7 million in 2020, according to the National Center for Equitable Care for Elders (ECE) at Harvard.
Yet drug abuse among older people remains underestimated, under identified, underdiagnosed, and undertreated. Substance use among older adults is especially complex as it is often not recognized because of other health-related aging conditions or is not treated effectively notes the ECE.
Social and physical changes that accompany aging may increase vulnerability to substance misuse. For example, older adults typically metabolize substances more slowly, and their brains can be more sensitive to drugs, according to the National Institute on Drug Abuse (NIDA).This problem has likely been exacerbated by the COVID-19 pandemic, as many older people in particular struggled with loneliness and social isolation.
NIDA also points out that older adults are more likely to experience mood disorders, lung and heart problems, or memory issues, compared with younger drug users. Both illicit and prescription drugs can worsen these conditions and the negative health consequences of substance use. And the effects of some drugs — like impaired judgment, coordination, or reaction time — can result in accidents such as falls and car crashes. These sorts of injuries can pose a greater risk to health than in younger adults and coincide with a possible longer recovery time.
Older adults are often prescribed more medicines than other age groups, leading to a higher rate of exposure to potentially addictive medications. Older adults make up about 15% of the U.S. population but account for more than one-third of all prescription medications. Older people may accidentally or deliberately misuse prescription drugs, which can exacerbate existing mental health issues. A 2019 study of patients over the age of 50 noted that more than 25% who misuse prescription opioids or benzodiazepines expressed suicidal ideation, compared to 2% who do not use them, underscoring the need for careful screening before prescribing these medications.
Data from national and state drug abuse and health agencies show:
- Many behavioral therapies and medications have been successful in treating substance use disorders, although medications are underutilized.
- Providers may confuse symptoms of substance use with other symptoms of aging, which could include chronic health conditions or reactions to stressful, life-changing events.
- Of the 2.2 million adults age 50 and older:
-
- 54 % used marijuana.
- 28 % misused prescription drugs.
- 17 % used other illicit drugs.
- Most admissions to substance use treatment centers in this age group are for alcohol, the most common drug of misuse among those seeking help at many drug treatment centers. Alcohol is one of the most damaging drugs to the human body; its effects on physical health and cognitive functioning can be devastating to someone already facing changes in mobility and cognition as a part of the aging process.
- People age 50 and older have lower tolerance for alcohol and a heightened response to over the counter and prescription medication.
- More patients 65 are admitted to hospitals for alcohol problems than for heart attacks.
Heavy drinking can worsen common health problems including:
- Diabetes
- High blood pressure
- Congestive heart failure
- Liver problems
- Osteoporosis
- Memory problems
- Mood disorders
The proportion of older people admitted primarily for heroin use has increased. At one rehabilitation facility in Albany, New York, it more than doubled in one year — from 11% (17 out of 155) in 2014 to 23.1% (six out of 26) in 2015, according to the New York State Office of Addiction Services and Support. The trend mirrors what is happening throughout the state, where the number of admissions for people age 50 and older to outpatient treatment programs statewide for opioids as a primary substance of misuse increased by 22% from 2,769 in 2010 to 3,370 in 2014.
Prescription medication misuse and abuse
- About 25% of nursing home admissions occur because the patient is unable to manage their medications.
- This misuse of prescription drug use indirectly causes up to 14% of hip fractures in adults 60 .
- 85% are currently taking at least one prescription drug.
- 20% use tranquilizers daily.
- 70% use OTC medications daily.
- Adults 65 use three times as many medications as those under 65.
- Older patients average two to three serious medication errors per month.
- Even patients who understand and agree with treatment are only 75% compliant.
- At least 40% don’t follow prescription directions.
- Many prescription and over-the-counter medications, as well as herbal remedies, can be dangerous or even deadly when mixed with alcohol. Medications that can interact badly with alcohol include:
- Aspirin
- Acetaminophen
- Cold and allergy medicine
- Cough syrup
- Sleeping pills
- Pain medication
- Anxiety or depression medicine
More science is needed on the effects of substance use on the aging brain, as well as into effective models of care for older adults with substance use disorders.
Opioid abuse is a problem for a growing number of older adults. As this presentation from Pitt Community College details, Medicare beneficiaries (aged and disabled) comprised the highest and fastest-growing rates of people diagnosed opioid use disorder—more than 6 out of every 1,000 beneficiaries.
Opioid abuse can also be the cause of elder abuse, by family members or others, according to the National Center on Elder Abuse. “Mounting reports of opioid misuse have been documented among elders addicted to drugs and their adult children who steal their medication. Though there is little data to quantify the breadth of the problem, reported incidents of opioid misuse often result in financial exploitation and may be accompanied by other, co-occurring forms of mistreatment such as emotional abuse and physical harm. “
Story ideas
- What does the data show about older adults and substance use in your county? Your state?
- What programs/services are available to specifically address and treat older people?
- How has COVID-19 affected alcohol or substance use/misuse among older people in your community? Are hotlines or facilities receiving more calls or admissions?
- Are any initiatives available to help family caregivers spot and approach a loved one whom they suspect may have a problem with medication or alcohol misuse?
- How are local health systems educating and training clinicians to better assess and treat this problem among their older patients?
- How have issues with opioid use among older people in your community gotten better or worse during the pandemic? What is being done to screen and treat those who may be dependent?
Resources
- National Center for Equitable Care for Elders
- National Institute on Drug Abuse
- University at Buffalo Clinical and Research Institute on Addictions
- Drug use among older persons a ‘hidden epidemic’, United Nations report, 2021
- Substance Use Disorders in Later Life (New England Journal of Medicine)
Experts
- Susan Lehmann, M.D., director of the Geriatric Psychiatry Day Hospital Program and associate professor of psychiatry and behavioral sciences at Johns Hopkins Medicine; slehman@jhmi.edu.
- Kenneth E. Leonard, Ph.D., director of the Clinical and Research Institute on Addictions and professor in the department of Psychology at the University at Buffalo; kleonard@buffalo.edu.
- Dilip V. Jeste, M.D., director of the Stein Institute for Research on Aging at the University of California, San Diego School of Medicine; djeste@ucsd.edu.
- Dawn E. Sugarman, Ph.D., assistant professor in the department of psychiatry at Harvard Medical School and research psychologist at McLean Hospital in the division of alcohol, drugs, and addiction; dsugarman@mclean.harvard.edu.
- Sue Peschin, CEO, and president of the Alliance for Aging Research in Washington, D.C.; speschin@agingresearch.org.
