Individuals over 65 have a decreased ability to metabolize drugs or alcohol along with an increased brain sensitivity to them. This makes it dangerous for seniors to use drugs or alcohol https://theconnectnetworktv.com/high-functioning-alcoholic-signs-risks-and-more/ at all, even if the person isn’t addicted. Barb is 72 years old and enters an inpatient treatment program after her three adult children intervene.
Chapter 4 Resources
Screening, assessing, and treating mental disorders (including depression and anxiety) within the scope of your practice, or referring to mental health services. Giving clients treatment and intervention substance abuse in older adults options for tobacco use disorder, pain management, and sleeping difficulties (e.g., CBT, relaxation training, exercise, physical therapy).692 Options should be scientifically supported and nonpharmacological whenever possible. Nonjudgmentally offer information about the ways alcohol can interfere with a medication’s effectiveness and increase the risk of harmful effects. Assessments should address risk factors related to late-life alcohol misuse among older adults (Exhibit 4.4). Assessment is a chance for you to use education as a prevention and early intervention tool.
Substance Use Disorders in Older Adults: Overview and Future Directions
- Older folx facing major life transitions or changes could be a key to unlocking and eventually treating underlying SUDs in older populations.
- Of note, older adults are at higher risk of developing delirium, having protracted withdrawal, and having worsening medical conditions as compared to their younger counterparts 35.
- Family members and physicians need to educate seniors on proper medication usage and side effects so they can avoid any potential misuse down the line.
- Older adults with a long history of heavy drinking, multiple past periods of treatment, or co-occurring mental disorders often need medically supervised withdrawal and age-sensitive, age-specific treatment to address multiple co-occurring conditions at the same time.
On the other hand, disulfiram should generally be avoided in older adults due to its contraindications with cerebrovascular disease, peripheral neuropathy, etc., that are more common in older adults 29. Aside from pharmacologic treatments, AUD is often treated with interventions such as twelve-step facilitation (TSF); in fact, there is high quality evidence that TSF interventions are more effective than cognitive behavioral therapy (CBT) for increasing heroin addiction abstinence in those with AUD 30. This review provides updated information on epidemiology, special considerations, and management of substance use disorders in older adults. As substance use disorders become more prevalent in older adults, primary care physicians must be prepared to recognize and diagnose substance use disorders as well as collaborate with and refer patients to geriatric medicine, geriatric psychiatry, and addiction medicine. The U.S. Preventive Services Task Force (USPSTF) recommends screening older adults for alcohol misuse and brief counseling for those who misuse alcohol 15. The Substance Abuse and Mental Health Service Administration (SAMHSA) Treatment Improvement Protocol (TIP) consensus panel recommends that all older adults be screened for alcohol, tobacco, prescription drug, and illicit drug use at least annually 14•.
Identifying Substance Abuse & Addiction in Seniors
The prevalence of opioid prescriptions in older adults continues to increase 54. As the population ages, there are increasing indications—whether appropriate or not—for opioids in older adults. Older adults have higher rates of chronic pain, and opioid prescription fill rates were disproportionately higher among adults aged 65 years or older from 2008–2018 55.
- The identification of SUDs in older adults is difficult as some signs and symptoms of substance use may be mistaken for symptoms of other chronic diseases or the natural course of aging 7.
- For a complete list of substance use treatment programs, consult the find addiction treatment dashboard.
- Belonging to an older cohort decreased the probability of ever receiving treatment (Blanco et al., 2015).
- One of the most common physical effects of substance abuse in older adults is an increased risk of falls and accidents.
Substance use disorders (SUDs) among the geriatric population are one of the fastest growing public health concerns in the United States 1. Chronic alcohol use, for example, can lead to liver disease, cardiovascular problems, and neurological damage. Similarly, drug abuse can exacerbate conditions such as hypertension, diabetes, and respiratory issues, increasing the risk of medical complications and reducing overall well-being. Inevitably, seniors are much more vulnerable to the development of various medical and mental health disorders.
Lynch et al. found that, among adult heroin users 65 years and older, 69% began using heroin before the age of 30 (typical onset) while 31% began using heroin after the age 30 (late onset) 57. Those with late-onset heroin use were more likely to use heroin more frequently and less likely to receive medication for opioid use disorder or residential treatment 57. There has also been an increasing death rate among older adults due to opioid overdose 58.
However, outpatient detoxification is less commonly employed in older adults given medical comorbidities. Of note, older adults are at higher risk of developing delirium, having protracted withdrawal, and having worsening medical conditions as compared to their younger counterparts 35. Acute inpatient treatment may be limited to medically supervised withdrawal followed by a step-down level of care to an intensive outpatient program (IOP), residential recovery-oriented rehabilitation program, or outpatient clinic 14•, 34. This chapter of TIP 26 presents facts about alcohol misuse, including AUD, among older adults.
Evaluation and Management of Alcohol use Disorder among Older Adults
This article presents an overview of epidemiology, service use, and clinical considerations on SUD in older adults and suggests future directions. SUD prevalence is lower in older versus younger adults, as are treatment rates among those with SUD. SUDs may be difficult to recognize and treat in older adults due to the presence of other psychiatric and general medical disorders.
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