Elderly and addictions

ALSO KNOWN AS: Elderly substance abuse

DEFINITION: The elderly populations of developed nations experience high rates of addiction and substance abuse , which often go unnoticed by society at large. These addictions are made more problematic by associated health problems and by generational attitudes that keep the elderly from seeking treatment.

Types of Elderly Substance Abuse

In all industrialized countries, the fastest growing age segment comprises persons age sixty-five years and older. Societal aging in the United States, for example, is projected to increase the proportion of the elderly from around 17 percent in 2022 to 22 percent by 2040, as baby boomers (persons born from 1946 through 1964) add about 70 million people to this age group. An estimated 17 percent of the elderly have health problems related to the abuse of alcohol and of legal drugs, including nicotine and over-the-counter (OTC) medications. One study documented a 107 percent increase in alcohol use disorder among adults aged 65 years and older from 2001 to 2013. A report from 2018 showed that nearly one million adults over the age of sixty-five reported a substance abuse disorder.

Alcohol . Researchers have long recognized the difficulties of accurately estimating rates of alcohol abuse among the elderly, with suggested rates that range from less than 2 percent to more than 20 percent. Elderly alcohol abusers often remain unnoticed compared with younger adults because they often drink at home and are less likely to have their problem drinking revealed by intervention at work or by legal problems, such as an arrest for drunk drinking. The elderly also are more self-conscious about their drinking and are reluctant to seek help because they view their addiction as a sign of low moral character.

Evidence that elderly alcoholism is a significant problem is the high rate of hospitalization for alcohol-related conditions among the elderly. Elderly alcoholics are characterized as either chronic or situational addicts. Chronic addicts are those who began abusing alcohol while young or middle aged; they typically have serious emotional or physical health problems as a result. Furthermore, their lives will be shortened if they do not significantly moderate their alcohol consumption. Situational addicts are those who began drinking in old age in response to disconcerting life events, such as the death of loved ones, dissatisfaction with retirement, or health problems.

Prescription and OTC drugs. The abuse of both prescription and OTC medications is a significant health problem for elderly Americans. Approximately 25 percent of all drugs prescribed are prescribed to the elderly. These drugs include highly addictive psychotropics and narcotics, such as benzodiazepines, Valium, and Librium. In 2019, Medicare drug plans limited all opioid prescriptions to a maximum of seven days for naive opioid patients. This and other limitations were put into place to manage who was prescribing the medications and the length of time patients were allowed to use such drugs as a means of curbing potential addiction. In 2022, there were approximately 130 million prescriptions for opioids in the United States, and around 12 percent of those prescriptions were from Medicare patients.

Confidential surveys indicate that almost one-half of the elderly take prescription drugs at higher dosages than prescribed, and that many elderly respond to their increasing addiction by inadvertently or deliberately obtaining duplicate prescriptions from more than one doctor. Prescription drug abuse is detected in only about 37 percent of elderly patients, compared with 60 percent of young adults, and serious negative health effects are more common for the elderly.

Many older people believe that the recommended dosages of OTC medications are irrelevant because they do not require prescriptions. The excessive use of some of the most popular OTCs, such as antihistamines, cold medications, and laxatives, can cause confusion, increased probability of stroke and heart problems, potassium and sodium deficiencies, and chronic diarrhea. Furthermore, many OTCs contain caffeine, which can lead to the abuse of OTC sleep aids.

The use of prescription and OTC medications combined with alcohol significantly increases the probability of addiction-related health problems for the elderly. Physiological changes that occur with aging, such as reductions in body mass, liver and kidney function, and body water, result in higher concentrations of drugs and alcohol for longer periods of time. Combinations of alcohol and drugs that remain in older persons’ systems for up to twice as long as in younger adults can have serious consequences, including emotional and mental problems, injuries from falling, and dangerous overdosing. The combination of OTC medications and prescribed medications from different doctors interacting is dangerous. The situation is known as polypharmacy and is estimated to cause death inone hundred thousand older adults each year.

Nicotine . The elderly suffer from more serious nicotine-related health problems than any other type of substance abuse. When the first rolled packaged cigarettes were marketed in 1913, few Americans smoked. Elderly cohorts still living came of age during the tobacco industry’s aggressive, effective, and deceptive advertising campaigns, which began in the 1920s. Among those endorsing smoking were actors, athletes, and physicians, who repeated the industry’s claims that cigarette processing eliminated the health risks and that smoking was part of a sexy, successful, fun-filled, and glamorous lifestyle. Also, tobaccos were being blended to maximize cigarettes’ addictiveness. By the 1960s, close to 50 percent of American adults were nicotine addicts.

About 10 million older American smokers now know that smoking is causally related to all of the leading debilitating and fatal medical pathologies. Only 10 percent report success in quitting, and 80 percent say that they wish they had never started smoking. Smokers live twelve years less, on average, than nonsmokers. In the United States, as of 2024, the medical expenses due to tobacco use were over than $300 billion each year, with about $225 billion for direct medical care for adults.

Diagnosis and Treatment Challenges

Among the reasons that elderly substance abuse is diagnosed at much lower rates than for younger abusers is the way in which many doctors respond to the symptoms of older patients. Research has shown that conditions like loss of balance or memory, physical or mental illness, and sexual dysfunction are often attributed to the normal decrements of aging rather than to addiction. Furthermore, many elderly abusers hide their addiction because they consider it stigmatizing. Many were functional abusers for decades and refuse to acknowledge the more pronounced effects on their health because of advancing age. In addition, some doctors and caregivers admit to ignoring the problem because they do not want to deny a source of pleasure to their elderly patients and clients.

Furthermore, many doctors are reluctant to diagnose elderly patients’ substance abuse problems because they are not convinced that the common rehabilitation approach, which involves peer groups and self-help programs like Alcoholics Anonymous, works well for the elderly. Older participants in these programs often assert that they think their abuse problem is different from those of younger group members, and they report feeling self-conscious and out of place. While self-help groups made up entirely of elderly participants do have higher success rates, physicians posit that these groups should be used in conjunction with interactive therapy by health care professionals.

Geriatric specialists point out that the treatment of elderly addicts can be complex. For example, emotional illness may cause substance abuse, but treating the underlying problem often involves prescribing addictive drugs, a true dilemma for physicians and other health professionals. Experts also point out the necessity of creating a treatment program that will probably require the interaction of medical and mental-health-care professionals and family members if an elderly abuser is to return to a healthy, abuse-free life.

Implications

In addition to the general concerns regarding the effects that the projected growth of the elderly population will have on the funding of elderly benefit programs such as Social Security and Medicare, there are concerns that future elderly cohorts will contain a much higher proportion of substance abusers. Baby boomers abuse licit and illicit drugs at much higher rates than do earlier generations, which may significantly increase elderly addiction-related policy issues.

Experts assert that the most daunting of these policy challenges involves the need for health care specific to substance abuse by the elderly. Current programs’ provisions are inadequate, and expanding such services to meet increased needs will be difficult, especially since cutting program expenditures is the focus of most initiatives.

Substance abuse and emotional illness often coexist, and Medicare, as of January 1, 2024, requires only a 25 percent copayment, rather than a 50 percent copayment that had been required previously. Still, many elderly addicts go untreated, and those who opt for substance abuse treatment often receive no follow-up mental health care. Elderly advocates have long argued that doctors too often dismiss elderly patients’ complaints about depression because their reported symptoms do not meet the requirements for a diagnosis of “major, or clinical, depression.” However, the elderly experience “minor, or reactive, depression” because of loss or other life changes at rates higher than any other age group. The elderly also commit suicide more than any other age group. One study found that 75 percent of elderly suicides had seen a doctor within one month of their death. Researchers estimate that baby boomers exhibit rates of addiction and emotional illness that are at least three times those of the current elderly population.

The federal agency that analyzes substance abuse by older Americans is the Substance Abuse and Mental Health Services Administration (SAMHSA). This agency evaluates the need for and promotes the availability of substance abuse services for this population. Since its creation in 1992, SAMHSA has published numerous reports that document the growing magnitude of the elderly addiction problem. After reviewing the available studies, consulting with experts, and identifying gaps in relevant data, SAMHSA publications have projected a significant increase in elderly substance abuse and call for policy initiatives that would greatly increase the availability of substance abuse prevention and treatment options for elderly cohorts.

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