Problematic Substance Use Is on the Rise Among Seniors

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Until relatively recently, health providers and researchers paid limited attention to alcohol and other drug use by older adults. But as baby boomers have turned 65, the age at which they qualify for Medicare, the incidence of alcohol and other substance use disorders among seniors has climbed steeply. Families, friends, and even healthcare workers tend to overlook concerns about the substance use of older people. Still, the reality is that anyone—at any age—can develop an unhealthy relationship with alcohol and other drugs.

The University of Michigan's 2021 National Poll on Healthy Aging found that a substantial subset of seniors significantly exceeded the recommended guidelines for alcohol use: 20 percent of respondents drank alcohol four or more times per week; 27% reported having six or more drinks on at least one occasion in the past year; and 7% reported alcohol-related blackouts.[1]

A 2022 study based on 2015-2019 data from the U.S. National Survey of Drug Use and Health focused on the prevalence of substance use disorders among Medicare beneficiaries, looking at the differences between Medicare enrollees under 65 (who qualify due to disabilities) and those 65 and older. Of the 2% of beneficiaries over 65 who reported a substance use disorder or dependence in the past year—over 900,000 seniors nationwide—more than 87 percent abused alcohol.[2]

In some cases, older adults have decades-long experience with regular use, while others develop a harmful reliance on alcohol and other drugs later in life. Sometimes, this is a result of major life changes, such as the death of a spouse, other loved ones, or friends, social isolation, relocating to new living circumstances, or failing health. These kinds of life-span challenges can cause loneliness, boredom, physical pain, fear, anxiety, sadness, or depression. And for seniors, any of these can lead to drinking too much as they seek to ease their mental, emotional, or physical discomfort.

It’s well known that excessive alcohol use has a variety of negative physical and mental health consequences, including heart and liver problems, memory issues, and mood disorders, as well as an increased risk of cancer and a weakened immune system.[3] However, the effects of alcohol change as we age, and age-related changes in the body place older adults at additional risk. Seniors have increased sensitivity to alcohol because they typically metabolize it more slowly. Moreover, muscle mass declines with age, and with less muscle to absorb alcohol, they feel the effects more quickly, even with consumption of smaller amounts of alcohol than when they were younger.[4] As a result, not only does tolerance to alcohol decrease as the body ages but drinking frequently worsens existing health problems and has dangerous interactions with some medications.

Sometimes, the effects of drinking in older adults are mistaken for other conditions related to aging, such as problems with balance or memory. Because seniors feel the effects of alcohol more strongly, they are more likely to have alcohol-related balance challenges that lead to falls and motor vehicle accidents. In 2020, alcohol accounted for 11,616 deaths among seniors, an 18% increase over the previous year.[5] Given that many older adults take multiple prescription medications, another important concern for this age group is the dangerous and sometimes fatal result of mixing medications with alcohol.

As people age, they often experience more pain-related conditions for which opioid pain medications are commonly prescribed. A 2021 study of opioid use disorder in people over 65 enrolled in traditional Medicare showed a threefold increase in just five years—to 15.7 cases per 1,000 in 2018 from 4.6 cases per 1,000 in 2013.[6]

Moreover, research published in JAMA Psychiatry in March 2023, using data from the Centers for Disease Control and Prevention collected from 2002 to 2021, indicates that the rate of overdose deaths among seniors quadrupled—from 3 to 12 per 100,000. These deaths were both intentional via suicide and accidental.[7]

While most seniors with substance use problems don’t die from overdoses, the health consequences are severe. They can contribute to other causes of death: injuries from falls and accidents, accelerated cognitive decline, heart and liver disease, and kidney failure. In turn, deteriorating physical health can have significant adverse effects on mental-emotional health, and older Medicare beneficiaries with substance use disorders were more than three times as likely to report “serious psychological distress” as those without—14% versus 4%. About 7% had suicidal thoughts, compared with 2% who didn’t report such disorders.[8]

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When it comes to engaging in substance use disorder treatment, older adults face some additional barriers, including higher rates of stigma about the difficulties inherent in admitting they have a substance use problem and concerns about what their family, friends, and neighbors might think. However, this obstacle can become a help-facilitating resource when family and friends observe an ongoing issue and address it with individuals with kindness, caring, compassion, encouragement, and practical—as well as emotional—support.

Copyright 2024 Dan Mager, MSW