2022 California Council of Community Behavioral Health Agencies (CBHA) Conference

Substance Misuse in Older Adults

In recognition of the State’s commitment to healthy aging, the American Association of Retired Persons (AARP) designated New York as the first Age-Friendly State in the nation. The Office of Alcoholism and Substance Abuse Services (OASAS) recognizes that a key component of healthy aging is preventing and treating substance use disorders (SUDs) among older adults and engaging them in activities that help sustain their recovery and improve their well-being. As the portion of our population over 65 grows, the SUD prevention and treatment field will need to become attuned to the unique biological, social, and emotional needs of this age group.

Baby Boomers have been the largest demographic group in the United States for much of the late 20th and early 21st centuries. According to the U.S. Census, when the youngest of the Baby Boomers turns 65 in 2029 “more than 20 percent of the total U.S. population will be over the age of 65.1” The healthcare system needs to be prepared to recognize and treat the signs and symptoms of SUDs in older adult populations. Unfortunately, research into substance misuse among older adults is limited and medical professionals often fail to identify SUDs in older adults. In an article published in the journal Gerontology, authors Birgit Koechl, Annemarie Unger, and Gabriele Fischer point out that the effects of substance misuse “can be mistaken for depression or dementia in elderly persons, which explains why the prevalence of addiction in the elderly is underestimated.”2

The consequences of SUDs among older adults are already apparent. A study published in the Journal of the American Geriatrics Society indicated that consuming “14 or more drinks per week is associated with an increased risk of subsequent falls in older adults.3” The 2016 Behavioral Risk Factor Surveillance System (BRFSS) indicated that nearly 8% of New Yorkers over the age of 65 engaged in binge or heavy drinking. In New York State, in 2017, 19% of all opioid deaths occurred among adults over age 55. Between 2011 and 2017, opioid overdose deaths among those 55 and older increased by 198%, which was the highest rate of increase among any age group.4

The number of people 55 and older admitted to OASAS-certified treatment programs with heroin or other opioids as their primary substance of abuse increased by 44% from 4,200 in 2012 to 6,100 in 2018. During the same period, the number of people 55 and older admitted to OASAS-certified treatment programs for alcohol as the primary substance increased by 39%, from 10,400 to 14,400. In 2010, those 55+ accounted for less than 10% of all admissions, but by 2018 they accounted for about 15% of all admissions. The Substance Abuse and Mental Health Services Administration (SAMHSA) notes that the number of older adults in need of substance abuse treatment nationwide is projected to be 5.7 million by 2020 which is more than double what it was in the early 2000s.5

Older adults are particularly vulnerable to the consequences of substance misuse for both biological and social/emotional reasons. As adults age they experience higher blood alcohol concentrations than younger peers due to decreases in body mass, liver function, and blood-brain permeability, as well as increases in neuronal receptor sensitivity to alcohol.6 Aging adults also process prescription medicines such as opioids and benzodiazepines differently than younger adults.7 Furthermore, other age-related health conditions can lead to an increase in prescription medicine use among this population. Using these medications improperly or in combination with alcohol can lead to devastating health affects among this population. Social isolation is also unfortunately associated with aging. Older adults may misuse substances to combat the loneliness associated with social isolation.

New York State has recently adopted the Prevention Agenda 2019-2024 with the goal of making “New York the Healthiest State for People of All Ages.” The Prevention Agenda 2019-2024 is New York State’s health improvement plan, the blueprint for State and local action to improve the health and well-being of all New Yorkers and to reduce health disparities for populations who experience them. OASAS, along with other stakeholders in the SUD field, participated in developing the priorities and goals of the Prevention Agenda, particularly the “Promote Well-Being and Prevent Mental and Substance Use Disorders” priority area. Preventing substance misuse among older adults is a key element to achieving the goals listed in the Prevention Agenda.

In 2018, Governor Cuomo issued Executive Order No. 190 “Incorporating Health Across All Policies into State Agency Activities” which requires every State agency to create policies that advance healthy aging across the State. This Executive Order will help fight isolation among older adult populations through community design, planning, zoning and development principles that foster social connection, civic participation, and promote well-being with a special consideration for the needs of older adults. These principles in concert with the Prevention Agenda’s focus on preventing SUDs will help to combat substance misuse among the older adult population.

The challenge of preventing and treating SUDs among older adult populations is daunting but not insurmountable. More research is needed to understand the prevalence and consequences of SUDs among this population as well as which evidence-based interventions are most effective in older adults. The myriad interactions between the older adult population and the healthcare system create numerous opportunities for health professionals to diagnose and treat SUDs. Outreach and education among geriatric health providers about SUDs in older adults is critical to assisting this population to thrive and flourish. OASAS is committed to working with our partners in the SUD field to prevent and treat substance misuse among older adults so that New York can lead the way as the healthiest state for people of all ages.

Footnotes

  1. https://www.census.gov/prod/2014pubs/p25-1141.pdf
  2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3540205/
  3. https://www.ncbi.nlm.nih.gov/pubmed/15209658
  4. https://www.kff.org/other/state-indicator/opioid-overdose-deaths-by-age-group
  5. https://www.samhsa.gov/data/sites/default/files/report_2792/ShortReport-2792.html
  6. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4146436/
  7. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4146436/

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