How to Care for Older Adults Facing Substance Use Disorders

America is aging. The Baby Boomer generation has largely entered retirement and, for many, social or health complications they faced in their youth have continued into their golden years. That includes drug use and addiction. 

More older adults than ever are being diagnosed each year with substance use disorders, but the capacity to provide quality, evidence-based care has not kept pace.  

This patient population—generally adults age 55 and older—faces challenges that younger patients often do not. Years or even decades of substance use may have taken a toll on their overall health. Their social networks may be smaller due to the loss of family members or friends. Many also hold long-standing beliefs about addiction treatment that no longer reflect current best practices. 

Because of these unique needs, the Cooper Center for Healing established a program specifically designed to care for older adults. The program is led by Jennifer Y. Moyer, MD. 

Dr. Moyer will present a lecture for the SNJMATCOE on March 6 focused on screening for, diagnosing, and treating substance use disorders in older adults. She answered the following questions about her presentation. 

You are presenting a lecture in March titled "An Aging Population: Caring for Older Adults with Substance Use Disorders." What should people interested in this talk expect from it? 

As our nation ages, we are seeing a new epidemic of older adults with substance use disorders (SUDs). In my lecture, I’ll talk about how SUD may look different in those who are older, challenges with screening these patients for SUD, diagnosis, and then different considerations for treatment.  

We will also be talking about delivery of care in nontraditional settings such as assisted living or skilled nursing facilities to capture more older adults in need of addiction care.  

Why are we seeing more SUD in older adults?  

The most common theory is that the Baby Boomer generation (those born between 1945–1965) is just getting older. This group, in their younger years, was more experimental with substances and are now just accessing healthcare more in general.  

Many of them have had intermittent use throughout their lives, or certain things have caused them to return to use, grief, pain, loneliness, changes in social structure, et cetera.  

What challenges exist in treating SUDs in this cohort?  

There are a few challenges in providing appropriate care to people in this age group.  

It can be difficult to diagnose someone with substance use disorder according to the DSM-5, the criteria we use for behavioral diagnoses, because their day-to-day activities are just different from someone younger. Older adults spend less time overall at work, or school, or participating in community activities, so it can be tough to determine how their substance use may be affecting their lives in that way.  

Some in this group are too medically complex to be accepted into an inpatient treatment facility, even if inpatient treatment would be beneficial. These facilities are not equipped to handle physical limitations or disabilities, cognitive impairment, dialysis, and so on.  

How does age bias come into play?  

Older adults are rarely asked about their substance use. Many just assume that people age out of addiction or drug use as they get older, but this is still a population that needs attention and care.  

There’s also a reluctance to prescribe medications in general for substance use disorders, including medications for opioid use disorder such as buprenorphine. This is mostly out of nervousness around a patient’s age and potential medical complications. 

Some health care providers also assume that older adults are too old to want to engage in treatment or change their ways, but that is simply not true.  

Polypharmacy concerns are more common in older adults. What should providers or pharmacists know about MAT and any risk of harmful interactions with other prescription drugs? 

It’s always a risk-benefit conversation, but, generally, health risks from ongoing substance use are often much more serious than trying the FDA approved medications we use to treat substance use disorders. It’s always a risk-benefit conversation.

There are certain things to consider with medication interactions, but that is on a case-by-case basis. 

Older adults sometimes live or spend long periods in assisted living or skilled nursing facilities. Can you talk a bit about substance use in these settings?  

It is easy to assume that people do not use substances in those facilities, but that is not the case. Many providers in these settings do not consider substance use, which means patients are often never diagnosed, let alone offered evidence-based treatment for any use disorders. 

On the other hand, for some, time in a facility can be very stabilizing and help to jumpstart their recovery with the right resources. 

The key is to acknowledge the person’s use history and have open conversations about treatment and goals. 

What else should health care providers in South Jersey know about SUD in older adults?  

With regard to substance use, this can be a particularly vulnerable patient population that is often unable to access treatment. Any providers who are willing to engage in this conversation and work with these patients can really make a difference.