Introduction

Substance abuse is a growing public health concern among older adults. With alcohol intake increasing in younger generations, we are likely to see patients continuing to use alcohol and other substances well into their later years.1 While substance use disorders (SUDs) are largely undiagnosed in the elderly, the number of Americans over age 50 diagnosed with a SUD is projected to double from 2.8 million in 2006 to 5.7 million by 2020.1,2 Among older adults admitted to hospital emergency departments, up to 30% will have alcohol dependency.1,3 Increasing numbers of older adults are also using opioids, cocaine, and marijuana. This population also tends to have more access to prescription medications with high risk of dependence and abuse.2 Approximately 25% of elderly patients with dementia and 20% of individuals over age 65 with a diagnosis of depression have a co-occurring SUD. 3 Older adults constitute a unique at-risk population for alcohol and other substance use disorders. Retirement is commonly associated with an increase in problem drinking, which may be difficult to recognize and monitor as older adults with SUD are likely to drink alone at home without supervision. Older adults with SUD are also likely to present with symptoms that are difficult to differentiate from symptoms of frailty syndrome, such as problems with memory, falls, incontinence, and functional limitations. Older adults who use substances and take multiple prescription medications are also at risk for dangerous pharmacological interactions and adverse effects.1

Interprofessional Assessment and Collaborative Interventions

Aging-related physiological changes are likely to increase sensitivity to effects of substance use in the elderly. Older adults are more prone to alcohol intoxication due to lower ratio of body fat to water, poor general health, reduced blood flow through the liver, and less efficient metabolism by the liver. These changes lead to higher blood alcohol content from a standard drink, which will be less tolerated by the body and lead to significant effects on the brain.1,2 Withdrawal from substances tends to last longer in older adults and carries high risk of medical and neurological complications.Confusion is a primary feature of alcohol withdrawal and older, frailer adults are often best managed in the in-patient setting.3 Geriatric psychiatrists and pharmacists should be consulted to manage treatment of withdrawal, as benzodiazepine doses will need to be adjusted based on the patient’s physical and nutritional status. Relapse prevention medications such as disulfam may not be tolerated well in the elderly and will need to be closely considered. Lactulose is another medication that may be contraindicated in older adults with SUD withdrawl, as resulting diarrhea may lead to fluid volume deficit and complications of incontinence and immobility.1

Over time, chronic substance abuse results in tissue damage to several organs, placing older adults with SUD at higher risk of developing hypertension, alcoholic liver disease, and even breast cancer in menopausal women.3 The goals of rehabilitation for older adults with substance use disorders are the same as for any patient with a chronic relapsing disorder: to keep up motivation to change, to alter attitudes toward recovery, and to reduce the risk of relapse.Primary care providers can continue to screen older adults in their practices for SUDs and provide referrals to geriatric psychiatrists, substance abuse counselors, social workers, and community programs as needed. Family members can assist in encouraging elderly patients with SUD to seek treatment, monitoring them at home for signs of substance abuse, and supporting them through recovery.

Interprofessional contacts for this topic:

Geriatric psychiatrists

Pharmacists

Primary care providers

Registered nurses

Substance abuse counselors

Social workers

Community health workers

Link to the following evidence-based protocols:

Age-related changes

Dementia

Depression

Substance abuse

References

1Richards, J., & Bradley, R. (2015). Alcohol and the older person. In A. McCune (Ed.), ABC of Alcohol (pp. 46-49). Hoboken, NJ: Wiley.

2Wu, 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.

3Caputo, F., Vignoli, T., Leggio, L., Addolorato, G., Zoli, G., & Bernardi, M. (2012). Alcohol use disorders in the elderly: A brief overview from epidemiology to treatment options. Experimental Gerontology, 47(6), 411-416.