Although rates of alcohol and drug abuse have generally been lower among older adults, the number of people 50 and older who have a substance use disorder is projected to reach 5.7 million by 2020. Older adults also often face problems such as chronic pain, social isolation and mobility issues that can make it harder to identify and treat addiction.
Prescription drugs are a major driver of substance misuse among older adults, but these patients are often reluctant to change their habits or medication regimens, Kate Lufkin, a cognitive behavioral therapist with Ochsner Health System, said this week at the Aging in America Conference in New Orleans.
"Older adults have a combination of painful diagnoses, social changes, psychological considerations and physical limitations," Lufkin said. "They also process alcohol and medications differently. … Mood-altering substances in older adults can mimic dementia, diabetes and depression."
While a family or personal history of addiction heightens the risk that an older person will develop a substance use problem, there are many other risk factors, including having mental health issues or a disability, being hospitalized, living in a long-term care facility or experiencing chronic pain, Lufkin said.America’s Deadliest DrugsView All 12 Slides
In 2016, an estimated 1 in 5 older adults had chronic pain, with higher rates among adults who lived in poverty, had less than a high school education or were publicly insured, according to research published by the Centers for Disease Control and Prevention.
When treating older adults, health care professionals should be diligent in trying to strike a balance between managing their patients' legitimate complaints of pain and ensuring they are using their medications appropriately, Lufkin said. When medications are legitimately prescribed, she said it can be harder for older patients or their families to acknowledge the drugs are being misused.
"For opioids, the biggest hurdle is getting people to say, 'Maybe I am taking this inappropriately. Maybe there is a better way,'" Lufkin said. "What they're thinking is, 'My doctor gave this to me and I feel better. Why would I stop?'"
Among adults 65 and older, the opioid-related overdose death rate soared 17.2% from 2016 to 2017, according to the CDC, and the age group was the only one to see an increase in death rate for overdoses involving prescription opioids between the two years.
Older adults who live in rural areas also may struggle to find doctors with experience treating addiction, Lufkin said, and if they can't drive or get to a clinic farther away, they may forgo treatment altogether.
Even if they can access treatment, she said, such programs are often designed for younger people or those who are otherwise healthy – meaning they may not be a good fit for older adults who also need to be treated for other health problems, she said.
These challenges underscore the importance of integrating addiction treatment into the primary care setting, Lufkin said – a shift widely recommended by public health experts. Additional efforts to address substance abuse among older adults also should consider health care costs and how older patients react to different medications, she said.
"We need to consider how pain impacts people differently," Lufkin said. "Yes, we need to cut down on some of these pain medications, because they're not doing you any good in the long term, but if they are allowing you to live your life, we have to consider that as well."