The Hidden Crisis: Substance Use Disorders in Older Adults

Introduction
The opioid poisoning crisis has cast a long shadow over the United States, affecting individuals across all demographics. However, one group that often goes unnoticed in this epidemic is older adults, otherwise known as somone’s parent, brother, sister, grandparent, etc.. 

Substance use disorders in this population are a growing concern, with an estimated one million older adults in the U.S. grappling with these challenges. 

Despite being equally likely to benefit from treatment as younger individuals, they are less inclined to seek help. This blog post aims to shed light on substance use disorders among older adults, discuss treatment strategies, and propose policy recommendations.

Substance Use Disorders Among Older Adults
Substance use among older Americans is a complex issue. Two-thirds of older adults with substance use disorders have a long-standing condition, often beginning before the age of 22, while the remaining one-third develop these challenges later in life. 

Several risk factors contribute to the development of substance use disorders in older adults. These include social isolation or loneliness, bereavement, chronic pain or illness, mental health conditions like depression, and changes in employment or living situations. As older adults navigate through various losses in their lives, substance use may become a coping mechanism.

The World Health Organization ranks opioid use disorders and alcohol use disorders as the second and fourth most stigmatized health conditions globally. This stigma, coupled with ageism, fuels misconceptions about older adults’ ability to adopt healthier behaviors. However, data shows that older patients can and do change, exhibiting similar recovery rates from substance use disorders as younger individuals when provided with treatment.

Treatment Strategies
Screening for problematic substance use is crucial, yet older adults are often overlooked. Annual screenings are recommended for all age groups, but healthcare providers frequently neglect to screen older patients. This oversight is particularly concerning given the high prevalence of problematic substance use and the increased risk of medical complications among older adults.

Moreover, when older adults are screened, the tools used are often not age-appropriate or capable of detecting common co-morbid and physical health conditions, such as depression and pain. Identifying substance use disorders in older adults can be challenging for healthcare providers, as symptoms can mimic those of other age-related conditions.

Access to services is another significant hurdle for older adults. Few specialized geriatric addiction treatment programs exist, and those that do, like Hazelden Betty Ford’s BoomerPlus program, require patients to be ambulatory and living independently. Other barriers include negative attitudes from providers and caregivers, lack of knowledge about diagnosis and treatment, and denial of a problem.

Financial constraints and technological barriers also pose challenges. Many older adults rely on Medicaid and/or Medicare and require treatment programs that accept these forms of insurance. The rise of telehealth services during the pandemic has the potential to increase access for many, but older adults may struggle with these new technologies.

When it comes to treatment, older adults are less likely than younger adults to receive a correct diagnosis for substance use. This is due to the difficulty in differentiating between symptoms of substance use and typical aging. Large discrepancies exist in treatment rates, with medication-assisted treatment (MAT) being underutilized and understudied in the geriatric population.

Substance use treatment for older adults must address addiction, mental health, and physical health. Age-specific physical health issues, such as medication management, chronic pain, physical movement, nutritional needs, and sexual health, must be considered. Mental health challenges unique to older Americans, such as cognitive decline, emotional distress from significant life transitions, and prolonged states of bereavement, also need to be addressedin treatment plans.

Policy Recommendations
To address the growing issue of substance use disorders among older adults, several policy recommendations can be made:

1. Increase Awareness and Education: There is a need for increased awareness and education about substance use disorders among older adults. This includes educating healthcare providers, caregivers, and the older adults themselves about the risks and signs of substance use disorders.
2. Improve Screening and Diagnosis: Healthcare providers should be encouraged to regularly screen older adults for substance use disorders. This includes using age-appropriate screening tools and being aware of the potential for substance use disorders to mimic other age-related conditions.
3. Expand Access to Treatment: Barriers to treatment need to be addressed. This includes increasing the availability of specialized geriatric addiction treatment programs and making these programs more accessible to older adults. This could involve accepting public forms of insurance, providing transportation assistance, and offering homecare services.
4. Promote Age-Sensitive Treatment Approaches: Treatment approaches need to be sensitive to the unique needs of older adults. This includes accommodating physical needs (e.g., mobility, hearing, or vision challenges), cognitive needs (e.g., memory and attention challenges), and learning needs (e.g., slower pace, repeating information).
5. Leverage Technology: While new technologies can pose challenges for older adults, they also offer opportunities to increase access to treatment. Resources should be allocated to train older adults in using these technologies, enabling them to fully benefit from telehealth services and smartphone applications.

​Conclusion
Substance use disorders among older adults is a significant yet often overlooked issue. By increasing awareness, improving screening and diagnosis, expanding access to treatment, promoting age-sensitive treatment approaches, and leveraging technology, we can make strides in addressing this hidden epidemic. It is crucial that we continue to work towards improving prevention and treatment of substance use disorders for all patients, especially older Americans.
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For more information about how to engage an eldery loved one struggling with problematic or chaotic use, please reach out here.

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