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Older Americans face a great deal of stigma. Perceived by many as “past their prime” or dismissed with a disdainful “OK boomer,” they’re often tucked away in senior care facilities or isolated at home. The isolation and loneliness not only increase the risk of serious health problems like dementia and stroke, but it’s also a recipe for another, often overlooked problem: substance use disorder (SUD).
Most people don’t think about grandma or grandpa having an addiction problem. Most of the concern and lament over the SUD epidemic centers around young people and lives lost “too soon” to overdose. But the reality is, anyone lost to addiction or overdose is lost too soon, and we must ensure every person—regardless of age—has the resources they need to get well and live their best, healthiest life as long as possible.
Unfortunately, we’re failing our seniors when it comes to SUD. Nearly 1.1 million Medicare beneficiaries are diagnosed with opioid use disorder, and last year 50,400 Medicare Part D beneficiaries overdosed on opioids. That’s in addition to alcohol, which is the most frequently reported substance of abuse for those aged 65 and older, especially among older women.
What’s driving elder addiction?
Elder substance abuse is fueled by many sources. Some have aged into addiction—they’ve had an SUD for many years, didn’t get treatment and the disease has progressed as they’ve gotten older. But many have developed addiction as they’ve aged through a variety of experiences. The isolation, shrinking of social circles and shift away from extended family with age can drive depression, which is a strong contributor to SUD. The pandemic certainly exacerbated the problem, forcing this high-risk population to stay home to protect themselves from COVID-19.
The aging process itself is also a contributor. Many older people suffer from increased physical pain, particularly in the feet, back or hips, and they turn to medication to alleviate the pain. Nearly one in four Medicare Part D beneficiaries received at least one opioid prescription in 2021, and nearly 200,000 received “high amounts” of opioids according to a recent study.
For many older Americans, substance use is also just not a concern. Families may think grandpa has “earned” the right to drink as much as he wants to, and at his age, what’s it going to hurt? Or they ignore it, chalking up the fact that grandma “has no filter” in her old age. But it could be that she’s under the influence.
The OD risk increases with age
Compounding the problem, older people are more susceptible to overdose, too. An aging metabolism slows the rate at which we’re able to break down medications, resulting in intensified effects. It might take less pain medication to provide relief, for example, but the individual continues taking it at the same dose, inadvertently creating an overdose.
Polypharmacy is also an issue. More than half of adults age 65+ take four or more prescription drugs, creating a drug cocktail with effects that we don’t fully understand. The same drug can have a different effect on separate individuals due to their unique body chemistry. Compound that with three of four drugs and an aging metabolism – there’s no way to predict the result.
Finally, naivete or an inability to be an advocate for their own care can be a contributing factor. While certainly physicians don’t intend any harm, doctors do make mistakes. And in some cases, older patients may forget to tell their physician about all the drugs they may be taking. Older folks tend to place unwavering trust in their physicians and are reluctant to question their recommendations or treatment, which puts them at risk of overdose, dangerous drug interactions or addiction.
How can we help?
Our senior citizens deserve the same level of compassion and care we’d provide to younger folks suffering from SUD. Here’s how we can help.
First, raise awareness. Geriatric practitioners and primary care physicians need to be more aware of the risk of SUD among older patients, and include mental health and substance use questions during wellness visits. Similarly, families need to be made aware of the risk and signs to look for. They must acknowledge that it’s not OK for granddad to be drinking a fifth of whisky daily. We’d recognize that as problematic behavior for a younger person, so why would it be OK for someone who’s older?
We should also target senior living centers with substance abuse education, informing staff about the risk factors and how to recognize the symptoms of an SUD. It may be that patients are falling or have stopped eating or bathing not because they’re old, but because they’re under the influence. Care facilities should be on the lookout for and discourage or forbid family members from bringing drugs or alcohol into their facilities.
We must also encourage older people to seek treatment. While access to treatment is a barrier—there aren’t many facilities with geriatric treatment options, and most don’t have the capacity or willingness to take on the liability (fall risk) of an elder patient—there are programs that accept or cater to older individuals.
Unfortunately, Medicare does not cover residential or intensive outpatient SUD treatment, despite reports that doing so would save $1.6 billion a year due to decreased medical costs and hospitalizations associated with SUD. But it will pay for detox and outpatient treatment. While this is not ideal, it’s better than no treatment at all. For patients who qualify for Medicaid, the coverage includes the full spectrum: detox, residential and outpatient treatment.
There are various resources for older Americans in the New England region looking for SUD treatment, including:
Prevent Overdose Rhode Island (overdose prevention resources and treatment locator).
Massachusetts Department of Public Health Opioid Overdose Prevention resources
Our elders deserve better
Older Americans deserve better than to be dismissed to battle addiction on their own, and as a community, we must demand greater access to treatment and payment by providers. Addiction is a disease, and just like heart disease, diabetes or cancer, it warrants treatment. We’d never overlook grandma’s breast cancer or grandpa’s high blood sugar; we’d make sure they got treatment as long as they were physically capable. They deserve the same compassion and care for alcohol or drug addiction.
Fred Trapassi is CEO of AdCare Hospital
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