Ahead of the joint international symposium hosted by the European Association of Geriatric Psychiatry and the American Association for Geriatric Psychiatry on Tuesday 7th December, Professor Rajesh Tampi of the AAGP highlights the growing problem of substance misuse in older adults, and how services can adapt to support this patient population.
In the United States, the population of older adults with substance use disorders (SUDs) is increasing steadily [1]. In 2020 there were approximately 5.7 million older adults with SUDs when compared to approximately 2.8 million individuals in 2006 [2]. As aging is associated with an increased burden of health-related issues and psychosocial stressors, the older adult population is considered an at-risk population for using psychoactive drugs [3, 4]. It is estimated that 1 in 4 older adults has used a psychoactive medication with an abuse potential with these individuals preferentially using alcohol, nicotine and prescription medications [3].
The risk factors for the development of SUDs among older adults include a history of substance use, comorbid psychiatric disorders and the presence of cognitive impairment [5]. Mitigating factors for SUD among older adults are being married, no previous history of substance use and a religious affiliation.
Older adults with SUD have greater rates of depression and suicide when compared to age matched controls [5]. Sustained use of psychoactive causes cardiac, hepatic and renal impairments that lead to higher rates of disability, morbidity and mortality [5]. In addition, the prolonged use of psychoactive substances can result in problematic drug-drug interactions and adverse neurological outcomes [3, 5]. When compared to age matched controls, the overall economic burden of care among older adults with SUD is greater due to the higher rates of co-morbidities, longer inpatient hospital stays and the increased need for more intense outpatient programs for symptom management [5].
SUDs among older adults are often poorly diagnosed and undertreated [5]. Lack of awareness regarding these disorders, denial of the disorder, the shame and stigma of using addictive substances, reluctance to seek professional help, lack of financial resources, the lack of social supports, the presence of comorbid conditions, limited time spent with their primary care physicians and the ageist attitudes towards mental health disorders among older individuals are all cited as reasons for the under-diagnosis and poor treatment.
The screening for alcohol and prescription drug use disorders as part of a regular physical examination among adults ≥ 60 years in age is recommended by the Consensus Panel of the Treatment Improvement Protocol (TIP) [6]. The routine use of standardized screening instruments like the Michigan Alcohol Screening Test-Geriatric (MAST-G) and the Drug and Alcohol Problem Assessment for Primary Care (DAPA-PC) can assist with the appropriate diagnosis of SUDs among older adults.
SUDs among older adults can be as successfully treated as SUD among younger adults [5]. The use of age-specific treatments, the use of supportive and non-confrontational approaches that build self-esteem, the emphasis on cognitive-behavioral approaches, the development of skills to improve social support, the use counselors who are trained and motivated to work with older adults and use of age-appropriate pace and content improve outcomes among older adults with SUD [4, 6]. Closer monitoring for drug interactions and adverse effects of medication treatments result in better outcomes for older adults with SUD [3, 7].
The United States Food and Drug Administration (FDA) has approved acamprosate, disulfiram, and naltrexone are for the treatment of alcohol use disorder [8]. Additionally, buprenorphine is approved for the treatment of opioid use disorder among adults. For the treatment of SUDs among older adults, the evidence for using these medications from controlled studies.
If you are interested in learning more about SUDs among older adults, please join us for the
International symposium: Addictions in older people
Presented by European Association of Geriatric Psychiatry & American Association for Geriatric Psychiatry
Tuesday 7th December 2021, 14.00 – 18.25 (GMT)
Online: MS Teams
Cost: £60.00 - EAGP and AAGP members / £75.00 - all non-members
*For ticket sales please click here
*Ticket price includes online access to the recorded sessions for six weeks after the event only available for registered attendees as part of the delegate package
Payment is by debit/credit card only and are non-refundable/transferable
For Nottinghamshire Healthcare NHS Foundation Trust employees (ONLY): please email
Programme, speakers’ biographies and all details can be found here
References
1. Kuerbis A, Sacco P, Blazer DG, Moore AA. Substance abuse among older adults. Clin Geriatr Med. 2014;30(3):629‐654.
2. Yarnell S, Li L, MacGrory B, Trevisan L, Kirwin P. Substance Use Disorders in Later Life: A Review and Synthesis of the Literature of an Emerging Public Health Concern. Am J Geriatr Psychiatry. 2020;28(2):226‐236.
3. Simoni-Wastila L, Yang HK. Psychoactive drug abuse in older adults. Am J Geriatr Pharmacother. 2006 Dec;4(4):380-94.
4. Wu LT, Blazer DG. Illicit and nonmedical drug use among older adults: a review. J Aging Health. 2011 Apr;23(3):481-504.
5. Tampi RR, Tampi DJ, Durning M. Substance use disorders in late life- A review of current evidence. Healthy Aging Research 4:27. doi:10.12715/har.2015.4.27.
6. SAMHSA, U.S. Department of Health and Human Services, Substance Abuse Among Older Adults, Treatment Improvement Protocol Series 26, DHHS Publication No. (SMA) 98-3179, 1998.
7. Menninger JA. Assessment and treatment of alcoholism and substance-related disorders in the elderly. Bull Menninger Clin. 2002 Spring;66(2):166-83.
8. Tampi RR, Chhatlani A, Ahmad H, et al. Substance use disorders among older adults: A review of randomized controlled pharmacotherapy trials. World J Psychiatry. 2019;9(5):78‐82.