Written by: Tasnova Malek, MD
This article outlines the serious problem of substance abuse and addiction among our elderly. It addresses many reasons an aging population may turn to alcohol and other substances to cope with the multitude of changes involved in getting older. With opioid pain management and the resulting opioid crisis, this subject is important to consider and we are reminded it is important to not only consider the physical health of our elderly population but also their mental health. This article was submitted courtesy of Dr. Malek for educational purpose only and should not be considered consulting or legal advice.
Aging leads to a multitude of changes each person must negotiate. It brings physiological, social, and psychological changes that can lead to the misuse of alcohol or other substances in an attempt to cope. The misuse can lead to delayed diagnosis— and help for the senior.
According to the Administration for Community Living, there were approximately 54 million people aged 65+ in 2019. Of seniors 60 years and older, about 17% live with some form of substance abuse, according to an article published by Michigan State University Extension. Although, alcohol misuse is the most common substance being abused by seniors. This is concerning to the medical community because studies designed to understand how alcohol and drugs impact an aging brain are few and far between.
What is known is that the aging brain is more sensitive to the introduction of chemicals as it struggles to break down and absorb alcohol or drugs. Alcohol metabolizes slower, which allows it to accumulate in the blood quicker, leading to intoxication without someone checking on the senior's consumption.
Memory issues (like forgetting to take or doubling up on medication) may lead to unintentional misuse, while other seniors use meds to cope with loss, declining health, grief, or changes to their living situations, among other issues. In addition, drug use/misuse may impair a senior’s coordination, reaction time, or judgment, aggravating an already risky situation. Some factors that put older adults at risk for substance abuse include:
- A previous/current mental illness
- Social isolation
- Financial concerns due to income changes
- Resistance to coping with a new living environment
How to Spot Addiction in the Elderly
Health issues are a natural part of the aging process. So, it can be challenging to know if memory issues, reduced focus and low energy are by-products of getting older or symptoms of an undiagnosed substance abuse issue. Consider these warning signs:
- Sleeping or eating habits that change
- Moodiness and irritability
- Erratic behavior
- Poor hygiene
- Unexplained bruising
Types of Substance Abuse in the Elderly
Alcohol abuse is the most common type of substance abuse in those over 65 years old, with 10% of seniors reporting that they binge drink, which is defined as five or more drinks on the same occasion for men, and four or more drinks on the same occasion for women.
Because chronic health issues tend to be part of the aging process, older adults are more often prescribed potentially addictive medicines compared to other age groups. And misuse of prescription meds may exacerbate existing mental health conditions.
Opioid Pain Medicines
Persistent pain is typically another challenging condition of growing old. In fact, opioid prescriptions for pain management in older adults increased ninefold from 1995 to 2010.
These may include the use of cocaine, or heroin, among others.
What Can Be Done to Address Elderly Addiction?
Recent data highlights the essential need to screen middle-aged as well as older adults on a regular basis. But it must include health care providers' and administrators’ efforts to develop the tools needed to work with older adults facing a debilitating addiction.
Health care professionals often mistakenly confuse substance abuse symptoms with other conditions that happen as a part of the aging process. As such, research is required to create screening methods that help detect substance abuse in older adults, which often work best with the application of coexisting medical and psychiatric conditions.
The most effective treatment and support for older adults with substance addictive issues are to leverage and coordinate the varying types of services by medical personnel (primary care physicians and addiction specialists, etc.) and community advocacy groups that support the senior community.
How to Treat Substance Use in Older Adults
There are a variety of behavioral therapies and medications that have been successful in treating substance use disorders in older adults. As noted above, there is limited research regarding the most effective model of care, although data suggest that older patients tend to have better outcomes the longer they receive the required care.
The ideal model for addressing elderly addiction includes the following –
- Regular diagnosis
- The management of current chronic medical conditions
- Re-building a network of support professionals
- Improved medical service access
- Enhanced case management capabilities
- Evidence-based training strategies for professionals working with seniors
The Bottom Line
There are many therapies and medications that can be used to successfully treat substance use disorders, in which many seniors respond favorably. It is never too late to choose to quit abusing any kind of substance, which, in time, will improve the future of one’s health and quality of life.
- nida.nih.gov - Substance Use in Older Adults
- canr.msu.edu - Substance Abuse in Older Adults - Underdiagnosed & Undertreated
- henryford.com - How to Spot Addiction in Seniors
- niaaa.nih.gov - What is Binge Drinking
Tasnova Malek, MD, graduated from Bangladesh Medical College and practiced as a primary care physician for six years in Bangladesh. After moving to the USA, she worked at Emory University Hospital in Pulmonary and Critical Care Medicine and Hospital medicine research. During COVID-19, she worked as a crisis counselor on the Florida Corona Virus Emergency Response Team. Currently, she is working in the National Suicidal Prevention Center and works reviewing articles for Sunshine Behavioral Health. In addition, she has extensive research experience in medicine and psychiatry in the USA.