Substance Use in Older Adults

Rates of all forms of substance use are increasing among older adults and alcohol and marijuana are the most commonly used substances. Although substance use poses harms to individuals at all ages, older adults are especially vulnerable to deleterious effects of substances, such as increased risk for falls and confusion. There are a number of factors that contribute to underdetection of substance use problems in older adults, including lack of time by providers during primary care visits, lack of age-appropriate screening tools to detect substance use, and lack of national guidelines for assessing older adults. Probing for alcohol use in the course of an interview or appointment in a respectful and nonjudgmental way may reveal problematic drinking. Marijuana is often seen as a “safer” alternative to alcohol, but can lead to adverse health effects. Prescription drug misuse is defined as the intentional or unintentional use of a prescribed medication that does not conform to prescribed directions. In addition to opioid medications, older adults are frequently prescribed benzodiazepines, both of which can cause confusion, cognitive impairment and increase fall risk. Alternative approaches to managing chronic pain and anxiety should be sought for older patients. Clinicians should inquire about use of illicit opioids among older adults and consider medication treatment with buprenorphine or methadone for this population. In summary, older adults should be asked about substance use of all types and clinicians need to be prepared to offer appropriate counseling and support services to reduce the risks of harm associated with this use.