Nearly one million adults aged 65 and older reported a substance use disorder (SUD) in 2018, according to a survey conducted by the Substance Abuse and Mental Health Services Administration (SAMHSA).
Special attention is required for seniors, age 65 and older when it comes to the prevention and treatment of substance use disorders (SUD). If experienced in later life, these conditions can accelerate the degradation of already age-diminished health — the ultimate consequence being an untimely death.
It is speculated that while illicit drug use generally declines after adolescence, aging could lead to social and physical changes that may increase vulnerability to substances.
“Alcohol is still the number one substance used and misused by older adults,” Cecelia Jayme, director of clinical services at Hazelden Betty Ford, told Addiction Treatment Business. “We also see some misuse of opioids, tranquilizers, benzodiazepines, and sedatives, among other substances. Because older adults are more likely than younger adults to have a variety of health conditions, they also are prescribed more medications, and while often necessary, medications—especially multiple medications—come with risks.”
Hazelden Betty Ford Foundation was founded in 2014 with the merger of the Hazelden Foundation and the Betty Ford Center. Headquartered in Center City, Minnesota, the addiction and mental health provider currently has 17 treatment centers.
Alcohol and prescription drug misuse
Over time, the abuse of alcohol causes harmful effects on brain structure and function that can lead to a decline in cognitive function and memory, according to a study conducted by the Stanford University School of Medicine.
“These findings provide compelling evidence that alcohol misuse during later adulthood could confer a greater risk of deficits… beyond the deficits that typically occur with aging,” Dr. Edith Sullivan, a professor of psychiatry and behavioral health sciences and lead researcher, told ATB.
Seniors taking daily medications are at serious risk for drug interactions with alcohol. Researchers from the University of California Los Angeles’ School of Public Health reported in the Journal of General Internal Medicine, that more than one in three drinkers aged 60 and above consume alcohol in quantities that are considered excessive or potentially harmful when combined with medications. Drinking can be especially dangerous for this demographic due to serum drug concentrations and drug toxicity.
“Older adults typically metabolize substances differently and are more susceptible to exasperated symptoms of other physical health such as heart disease and lung problems,” Jayme said. “They also are at greater risk of injuries due to falls.”
Prescription drug abuse
Prescription drug use also can be concerning for this population and may lead to accidental addiction. Seniors are often more likely to unintentionally misuse medications by forgetting to take their medicine, taking it too often, or taking the wrong amount.
Health conditions that develop as part of the aging process also lead to a higher rate of exposure to potentially addictive medications, such as opioids, which are the second most commonly reported substances of abuse by seniors.
According to drug overdose mortality data from the National Center for Health Statistics, individuals born between 1947 and 1964 are the demographic group most affected by the United States’ current opioid epidemic. Since 2010, individuals in this age group have experienced significantly increased rates of death from a prescription opioid overdose.
Providers should be aware that SUD symptoms are often difficult to recognize in older adults due to medical comorbidity, neurocognitive impairment, and functional decline, according to Jayme.
“Signs can include changes in behavior as well as changes in mental abilities,” Jayme said. “Drinking, misusing medicines, or using other drugs often starts after a big change in a person’s life. Retiring, the death of a spouse or good friend, leaving your home, or being diagnosed with a disease are all sorts of things that can trigger increases in substance use.
However, spotting SUD in older adults can be difficult, especially in those with previous cognitive challenges.
“Make sure you are aware of what you are hoping to address,” she said. “When you are ready, try to talk to the older adult when they are not under the influence, approach them with love and kindness, and use phrases that explain how you feel and what you are concerned about rather than being confrontational. Try to find out what prescriptions they are taking, the physicians they are seeing, how they’re dealing with any significant life changes, their current conditions, and who else is in their circle of support.”
Ideally, treatment would include diagnosing and managing chronic conditions, rebuilding support networks, improving access to medical services, improving case management, and staff training in evidenced-based strategies for this age group.
Jayme said that while no treatment meets every elder’s needs, many options will meet specific needs.
“It is best to have a medically managed detox for older adults,” she said. “Withdrawal from alcohol and sedatives is physically debilitating, and there is a high risk of complications in withdrawal from those two forms of substances. Medically managed detox will support the older adult and provide the medical care needed for a safe withdrawal process.”
Additionally, there are opportunities for providers to offer residential, outpatient and group therapy programs, according to Jayme. The level of care is dependent on the patient.
Treatment programs should deliver age-friendly care that integrates the principles of geriatric-based care. The goal should be integrated and coordinated care focusing on maintaining function and managing chronic conditions in coordination with SUD treatment. Fragmented care, especially for patients with multiple conditions taking a variety of medications, increases the likelihood of drug interactions.
Clinicians focusing on caring for older adults must be comfortable with screening, recognizing, and diagnosing SUD and can provide a timely referral to a treatment facility when needed.
“Making sure providers are educated about the risks and the community resources available for the older adult is important,” said Jayme. “Having the courage to ask the questions about medications, use of alcohol, and emotional wellness is critical in helping to identify issues and refer people for appropriate care and support.”
