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Treatment for the Elderly

As a group, elderly individuals have historically had relatively low rates of alcohol and other illicit drug use when compared to other age groups; however, as the Baby Boomer generation grows older, rates of use of these substances in aging adults are climbing.

Rates of illicit substance use in the past year has nearly doubled in each of the age brackets above 55 that are tracked annually by the National Survey on Drug Use and Health. Past year illicit drug use in adults aged 65 or older climbed from 3.0% in 2013 to 5.7% in 2018.1,2  For adults aged 60–64, past year illicit drug use was 6.5% in 2013 and hit 13.0% in 2018.1,2 For adults aged 55–59, drug use in the past year was 8.6% in 2013 and hit 15.2% in 2018.1,2

The number of older Americans with a substance use disorder is expected to rise from 2.8 million in 2002–2006 to 5.7 million by 2020.3

Risk Factors for Substance Abuse in the Elderly

Getting older results in various changes, such as changes in life obligations, changes in health, and even changes in one’s circle of family and friends. Some of the major risks associated with an increased probability of developing a substance use disorder in elderly individuals include:4

  • Being male carries a higher risk for alcohol use disorder.
  • Being female carries a higher risk for misuse of prescription drugs).
  • White race.
  • Chronic pain, physical illness, and/or physical disabilities.
  • Taking multiple drugs or having a significant drug burden.
  • Previous substance use.
  • History of psychiatric illness or having a current psychiatric illness.
  • History of having problems with alcohol.
  • Using avoidance as a coping style.
  • Social isolation and/or living alone.
  • Lower economic status.
  • In grief and mourning after recent death(s).
  • Being forced to retire or having to retire unexpectedly.

Factors associated with prescription medication abuse in older adults include a history of a substance use disorder and medical exposure to prescription drugs with abuse potential.4 Being a smoker increases the risk of having problems with alcohol.5

The probability of substance use, specifically alcohol, is high for older adults suffering from depression and other affective disorders.4 At the same time, at-risk and problem drinking among the elderly are likely to exacerbate depressive disorders.6 At-risk drinking and co-occurring depression are associated with suicide ideation and completed suicides.6

Signs of Substance Use Disorders in the Elderly

Although the formal diagnosis of any substance use disorder is made according to criteria applied to all age groups as published in the Diagnostic and Statistical Manual of Mental Disorders (DSM),7 evidence points to some signs that may indicate there is a substance use disorder include physical, psychiatric and social signs and symptoms.

Physical signs or potential indicators include:4

  • Injuries (falls, bruises, burns).
  • Headaches and/or dizziness.
  • Increased tolerance to alcohol or medication.
  • Blackouts.
  • Cognitive impairments (e.g., disorientation

Psychiatric symptoms or potential indicators include:4

  • Sleep disturbances.
  • Anxiety, depression, and/or mood swings.

Social symptoms or potential indicators include:4

  • Legal, financial and family problems.
  • Loss of a partner or spouse.
  • Needing extra supplies of medication and borrowing from medication from others.

Research and surveys, such as those sponsored by the Substance Abuse and Mental Health Services Administration and the National Institute on Drug Abuse, provide data on the use, misuse, and abuse of drugs by the elderly. The data indicates the following:

  • The most common form of substance use disorder in elderly individuals is alcohol use disorder.8
  • Older adults are at high risk for misusing prescription medications, such as opioid analgesics for pain and central nervous system depressants like benzodiazepines, due to conditions like pain, sleep disorders/insomnia, and anxiety that commonly occur in this population.9
  • Benzodiazepines, drugs that are prescribed for anxiety, seizure control, or to induce sleep, are the most misused and abused prescription medications in elderly individuals.4
  • The combination of alcohol and benzodiazepines can be particularly serious for anyone, and the potential dangers of taking these drugs together are increased in the elderly.4,9
  • Substance use among older adults has been found to continue and even be enabled in nursing homes.4
  • A significant percentage of hospital admissions associated with elderly individuals may stem from alcohol or drug abuse or misuse.8

Treatment for Elderly Individuals

Elderly individuals respond just as well to standard treatment protocols for substance use disorders as other groups. When seeking treatment for an elderly individual, keep the following in mind:

  • No one treatment works or is an appropriate program for all individuals.10While there are a number of different approaches to treating substance use disorders that have empirical validation, there is no specific “one-size-fits-all” treatment approach. It is important to match the treatment with the individual client. For instance, elderly individuals may be resistant to attending group therapy, especially where there are many younger adults. The use of individual therapy for these individuals or finding a treatment program specifically geared toward older adults may be more effective.11
  • The treatment needs to be available.Elderly individuals have a number of restrictions that may keep them out of certain forms of treatment. If the treatment is not available, it cannot be useful. If the individual does not attend treatment, the treatment cannot be effective.10
  • Elderly individuals as a group have specific needs.Successful substance use disorder treatment must address the needs of the individual. Treatment should be appropriate for the individual’s age, cultural background, and medical condition.10,11
  • Effective substance use disorder treatment meets the special needs of the person.Elderly individuals are often isolated, feel lonely, or may have some cognitive issues. Effective substance use disorder treatment addresses the specific needs and capacities of the individual.10,11
  • Treatment must continue for an adequate period of time in order for it to be effective.There is no “quick fix” approach to treating a substance use disorder. Keeping elderly individuals engaged in treatment programs is a key issue to their success.10

Overall, there are several major considerations that apply to increasing the effectiveness of treatment protocols focused on elderly individuals. These include:

  • Understanding the effects of medications and alcohol:9,12The use of prescription medications and alcohol by elderly individuals results in significantly different effects than what occurs in younger individuals.6 Older individuals often need lower doses of prescription drugs for medicinal reasons and respond differently to alcohol and drug usage than do younger individuals.9 Medication use in elderly individuals often needs to be controlled and monitored closely.9
  • An increased need for public awareness and identification:4,12 Substance use disorders cannot be treated unless they are identified in individuals. There is an increased need for public awareness regarding substance use disorders in elderly individuals and the identification of the potential signs and symptoms of substance abuse by elderly individuals by physicians, relatives, peers, caregivers, etc.4,12 The use of screening and diagnostic tools for the detection of substance use disorders should be increased among caregivers and treatment providers of elderly individuals.4,6,12
  • Increased access to care:4 There remains a relative shortage of behavioral healthcare service providers who are trained to serve older adults. There is also a shortage of behavioral healthcare programs designed specifically for elderly individuals. These services need to be increased.
  • Integrating substance use disorder treatment of primary care:4,12 Because many elderly individuals with substance use disorders do not readily attend therapy or support groups, it is important that primary care for these individuals also incorporates substance use disorder treatment.
  • An increase in research:4 Increasing research efforts to identify effective assessment tools and treatment protocols specifically designed for elderly individuals is an extremely important aspect of serving this population.
  • Integrated treatment protocols should be implemented for this population:12,13Because the available evidence suggests that a large number of elderly individuals who develop substance use disorders have co-occurring conditions, such as depression, issues with anxiety, feelings of isolation, and other potential mental health disorders, it is extremely important that all of these issues be treated concurrently and coordinated with primary care.13 Such a program should also involve the use of a multidisciplinary treatment team that includes physicians, therapists, social workers, case managers, and other treatment providers who work with the individual across a number of different domains.6

References

  1. Center for Behavioral Health Statistics and Quality. (2019). Results from the 2018 National Survey on Drug Use and Health: Detailed Tables.Substance Abuse and Mental Health Services Administration, Rockville, MD.
  2. Center for Behavioral Health Statistics and Quality. (2015). Results from the 2014 National Survey on Drug Use and Health: Detailed Tables.Substance Abuse and Mental Health Services Administration, Rockville, MD.
  3. Wu, L. T., & Blazer, D. G. (2011). Illicit and nonmedical drug use among older adults: A review. Journal of Aging and Health, 23(3), 481–504.
  4. Kuerbis, A., Sacco, P., Blazer, D. G., & Moore. A. A. (2014). Substance abuse among older adultsClinics in Geriatric Medicine, 30(3), 629–654.
  5. Moore, A. A., Giulu, L., Gould, R., Hu, P., Zhou, K., Reuben, D., Greendale, G. & Karlamangla, A. (2006). Alcohol Use, Comorbidity, and Mortality. Journal of the American Geriatrics Society, 54(5), 757–762.
  6. Miller, S. C., Fiellin, D. A., Rosenthal, R. N., & Saitz, R. (2019). The ASAM Principles of Addiction Medicine, Sixth Edition. Philadelphia: Wolters Kluwer.
  7. Diagnostic and statistical manual of mental disorders: DSM-5. (5th ed.). (2013). Washington, D.C.: American Psychiatric Association.
  8. Mattson, M., Lipari, R. N., Hays, C. & Van Horn, S. L. (2017). A Day in the Life of Older Adults: Substance Use Facts.
  9. Substance Abuse and Mental Health Services Administration & Administration on Aging. (2012). Older Americans Behavioral Health Issue Brief 5: Prescription Medication Misuse and Abuse Among Older Adults.
  10. Substance Abuse and Mental Health Services Administration. (1997). A Guide to Substance Abuse Services for Primary Care Clinicians. Chapter 5: Specialized Substance Abuse Treatment Programs.
  11. Kuehn, B. M. (2015). Substance Use Treatment for Older Adults.
  12. Center for Substance Abuse Prevention, Substance Abuse and Mental Health Services Administration. (2017). Get Connected: Linking Older Adults with Resources on Medication, Alcohol, and Mental Health.
  13. Center for Substance Abuse Prevention, Substance Abuse and Mental Health Services Administration. (2016). Growing Older: Providing Integrated Care for An Aging Population.
About The Contributor
Ryan Kelley, NREMT
Medical Editor, American Addiction Centers
Ryan Kelley is a nationally registered Emergency Medical Technician and the former managing editor of the Journal of Emergency Medical Services (JEMS). During his time at JEMS, Ryan developed Mobile Integrated Healthcare in Action, a series... Read More