Substance Use Among Older Adults
Although in recent years research has focused on substance use among adolescents and young adults, substance use disorders (SUDs) among older populations are not uncommon. However, they can be difficult to detect and are associated with poorer clinical outcomes. The increasing prevalence of SUDs in older populations may be the result of a cohort effect since “baby boomers” were adolescents or young adults in the 1960s and 1970s when alcohol and drug use was becoming more acceptable. Drug use among the older population is often complicated by the existence of chronic health conditions such as diabetes, hypertension, dementia, and heart disease which may account in part, for poor clinical outcomes in this population. Lifetime exposure to trauma and the effects of aging on physical and cognitive abilities may make screening and intervention particularly challenging.
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Despite the risks associated with alcohol or drug use in this population, research data is limited. Differences in the definition of “older” or “elderly” may differ from study to study making comparisons and generalizations across studies difficult. For example, the National Survey on Drug Use and Health (NSDUH) collapses age related data into categories of 12-17 years, 18-25 years, and 26 and older.
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Data from the Agency for Health Research and Quality (AHRQ) Medical Expenditure Panel Survey on use of opioids by elderly adults (65+) from 2015-2016 found that 19.3% of elderly adults on average filled at least 1 outpatient prescription and 7.1% obtained 4 or more prescriptions during the year. Individuals who were classified as poor (below federal poverty level) or low income were more likely than middle or high income individuals to have to fill a prescription for an opioid medication (20.8% vs. 11.3%). As rates of outpatient opioid use increased, perceived health status declined. Individuals with Medicare or other public insurance coverage (24.4%) were more likely to fill at least 1 prescription and to have 4 or more prescriptions (11.2%) compared to those with Medicare only (18.8% and 7.6% respectively). Non-Hispanic Whites and those residing in a metropolitan statistical area (MSA) were more likely to have filled a prescription compared to other ethnic groups or those who did not reside in an MSA.
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A recent retrospective cohort study by Zullo et al. (2020) using Medicare enrollment data found that among 7,243,208 Medicare beneficiaries 65 and older with 1 acute inpatient hospitalization in 2016, 16.7% had a primary diagnosis of opioid use disorder (OUD) and 83.3% had a secondary diagnosis of OUD.
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These researchers also found that discharge to a skilled nursing facility was more likely for those with OUD-related diagnoses.
The findings from the studies cited above suggest that older adults may be a neglected and emerging risk group for opioid misuse. Risk factors for this group include pain associated with chronic medical conditions, depression, loneliness or limited access to medical care. At present, research on prevalence and outcomes associated with drug use in this demographic is very limited. There is also a need for evidence-based interventions tailored for this population. The study by Zullo et al (2020) highlights the need for raising awareness among caregivers and service providers of the elderly, including those who may reside in skilled nursing facilities.
Resources
Agency for Healthcare research and Quality (AHRQ) Medical Expenditure Panel Survey (MEPS).
The MEPS is a set of large-scale surveys of families and individuals, their medical providers and employers across the United States. MEPS is the most complete source of data on the cost and use of health care and health insurance coverage.
Network for Public Health Law Resource on Information and Data-Sharing Resources
Centers for Disease Control and Prevention
The Network for Public Health Law provides a database of tools and resources for data-sharing between health agencies to navigate legal barriers of data-sharing, HIPAA compliance, and other policies and regulations.
Any Use and Frequent Use of Opioids Among Elderly Adults in 2015-2016 by Socioeconomic Characteristics
Agency for Healthcare Research and Quality
This statistical brief presents estimates from the 2015 and 2016 Medical Expenditure Panel Survey Household Component (MEPS-HC) of fills of prescriptions for opioid medications that are commonly used to treat pain.
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LeRoux C, Tang Y, Drexler K (2016). Alcohol and Opioid Use Disorder in Older Adults: Neglected and Treatable Illnesses. Current Psychiatry Reports; 18, pg. 87
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Substance Abuse and Mental Health Services Administration. (2019).
Key substance use and mental health indicators in the United States: Results from the 2018 National Survey on Drug Use and Health
(HHS Publication No. PEP19-5068, NSDUH Series H-54). Rockville, MD: Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration. Retrieved from
https://www.samhsa.gov/data/
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Zullo AR, Moyo P, Jutkowitz E, Wenhan Z, Thomas KS (2020). Opioid Use Disorder Among Hospitalized Older Adults: Prevalence, Characteristics, and Discharge Status
. Journal American Medical Association 21
(4); pg. 557-559.
