Older Adults and Substance Misuse
Often times in Prevention we focus on those under 21 and parents of those children. Recently, I was made aware of a growing public health emergency. Older adults are quickly becoming a growing demographic in our community and unfortunately, they are also at an increased risk of substance misuse. These incidents are underreported and undertreated. First, I want to start this by saying that what I am about to say does not apply to every elderly person, but it is important to note that we need to talk about this.
I also want to note that older individuals grew up in a very different time than we are in when it comes to alcohol and substance use. Some grew up or remember Prohibition. Some grew up during the 60s and 70s when psychoactive drugs became popular. Some remember the infamous “Reefer Madness” film which I will not give any more attention. The 80s were filled with sex, drugs and rock and roll. So, when we have this conversation, we need to be mindful of the individuals involved. It does not mean that they should “get a pass” to use alcohol and other substances as they fit. It does not mean that they should not consume anything as they are adults.
How do we approach this conversation? First, we need to think about the possible risks of older individuals using alcohol or other substances. Much like children, older brains do not function the same and with the addition of alcohol or other substances, coordination, problem solving skills, judgement and reflexes are impacted. We need to consider that older individuals are more likely to have chronic health conditions (diabetes, arthritis, heart problems, etc.) that require prescription medication to manage. Adding alcohol or other substances to prescriptions can increase drug interactions, adverse side effects and related injuries such as falls and traffic accidents.
Changing Demographics
In 1960, there were only 1 million people over the age of 85. In 2020, there were approximately 7 million and by 2040 we will have approximately 15 million individuals over 85.
In 1960, there were approximately 17 million individuals ages 65-84. In 2020, there were 47 million and by 2040 there will be 65 million individuals ages 65-84.
While older individuals have been overlooked for decades, we are suddenly faced with a huge increase in their population numbers. With this increase will come an increased need for health care, mental heath services and ultimately prevention and treatment. Studies are still being conducted and many more are needed but we know on the surface that older individuals are engaging in risky alcohol use, cannabis and illicit substance use and are presenting with mental health disorders. Older individuals can experience these things by choice or in response to stressors such as loss of a loved one, social isolation, boredom, untreated pain and loss of independence.
Currently 1 in 5 older individuals admit to drinking 3-4 drinks per day.
- 10% of those individuals drank while taking prescriptions or using other substances
- 20% experienced alcohol-related blackouts or reported a loss of time
- 1 in 10 older individuals meet the criteria of binge drinking
- Men are 1.5 times more likely to be injured due to alcohol/substance misuse
- Hospital admissions for mental health disorders related to alcohol has increased 21% since 2016 in those over the age of 50.
What Can We Do?
First, we need to work to reduce and eliminate stereotypes, stigmatizing language including in media portrayals. How many times have you seen a character like Red on “That 70s Show” or Bobby on “Supernatural” or Hopper on “Stranger Things” who are older and are defined by their drinking? These portrayals are damaging because they only tell a small part of the story. Yes, there are those who misuse alcohol at any age.
In older adults there may be changes in tolerance and metabolism. Maybe they could drink 4 or 5 beers after work at 30 but by 60, a single beer will cause the same impacts. A single beer might impact their balance, slur their speech, slow their reflexes.
Alcohol is not the only substance that older individuals are using. Cannabis use is increasing as legalization increases. It is not just low-income individuals. Those with higher incomes are more likely to use cannabis. Monthly use is skyrocketing. Again, we have to consider their age and the social climate around substances when they were younger. Many older people grew up where cannabis was a very common substance and you could buy alcohol before 21. Some older adults went through decades of not using cannabis and are now using again. Illicit substance use has also increased. Opioids and benzodiazepines are the most commonly misused substances. Substance use disorders among older adults are among the fastest growing health problems in this country. Despite knowing this, the numbers are underestimated, under indicated, under treated, and under diagnosed.
Meaning that often times friends, family, loved ones and even health care professionals disregard alcohol and substance use. Have you ever heard the old saying “the simple pleasure” or “if that is all they do, let them.” This attitude that older individuals drinking or using substances is harmless may place them at a higher risk for illness, injury, misuse disorders and even death. Many older individuals fall or are involved in car accidents. However, there are no standards to determine if these incidents are related to alcohol or misuse of other substances. Sometimes, older individuals simply forget that they already took their dose of prescription x or that they cannot eat/drink x for however much time after taking prescription x. Even that sounds confusing to me.
So, what can we do? First, be kind, show mercy and have compassion for our older individuals. They come from a different generation but they also took care of us as we grew up. It is our time to take care of them. Right now, more older adults meet the criteria for substance use disorders than any previous generations. If you know an older individual who requires multiple medications, offer to be a part of their lives. Don’t try to control it but offer your assistance and your companionship. Many older individuals are overwhelmed by their day to day and also experience loss of time more often than younger individuals. They may sleep in and miss appointments, nap throughout the day or experience abnormal sleep cycles with or without medication. Perhaps, a little more attention, a little more kindness could really help them.
Understand that while older individuals may believe that they are “fine” when consuming alcohol, they are most likely to have adverse reactions to alcohol and substances. The risk for hip fracture is doubled when older individuals engage in heavy drinking. Older individuals are also more likely to consider suicide due to some of the stresses that I mentioned above. The risk increases with use of other substances. Older individuals are also not fragile creatures who necessarily need every step of their lives controlled. They are valuable members of society, they have friends, spouses, children.
Some health care professionals have seen older individuals engage in “learned behavior” with their medications. They may have been prescribed a sleeping pill, benzodiazepine or other prescription due to a traumatic event. However, they soon realize that the pill makes their life a little “easier to deal with” and can in turn begin to rely on that prescription to get through their daily life. They are not drug seeking. They are trying to cope with significant changes and losses in their life. The changes are very abrupt and the less that they have outside contact, the more likely they are to turn to alcohol, prescriptions or other substances to cope. That is a universal symptom of substance use. It is based in trauma.
Be mindful and not accusatory. Instead of scolding, empower older individuals. Help find ways for them to navigate their new lives and retain as much independence as they can. Buy them pill boxes and help them fill them. Go with them to medical appointments and help them understand what is being said so that they can follow the orders given. Be mindful of how you deliver information to older individuals. Do not just hand them brochures. Over 70% of older individuals struggle reading printed material due to font size or the overwhelming nature of the material. 80% struggled with forms and charges and nearly 70% struggle with numbers and calculations.
Try to find ways to remind them of important dates, appointments, etc. that they can use independently. If this is not possible, then be kind and supportive when helping them. Don’t force yourself on them or expect them to do things “your way.” If you have concerns, educate yourself on their health conditions, the prescriptions that they take and be mindful of how much alcohol they have in their home.
Overall, just be there.