Updates in Geriatric Psychiatry-view handout: slides

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Substance use disorders, including tobacco, alcohol, and opioids, are prevalent among older adults. Approximately 1 in 4 older adults have used a psychoactive substance with abuse potential. Tobacco use is more common among older individuals aged 50-64 compared to those aged 65 and older. Alcohol use is seen in about half of adults aged 65 or older, with 13% of men and 8% of women reporting at-risk use. Marijuana use is relatively low at 0.7% in the past year among adults aged 65 and older. Cocaine, inhalants, hallucinogens, methamphetamine, and heroin use is very low among older adults.<br /><br />Benzodiazepine use is prevalent among older adults, with 1 in 10 using them in any given year. Risk factors for benzodiazepine use include female sex, cognitive impairment, panic disorder, suicidal ideation, and difficulty obtaining help for emotional problems.<br /><br />The opioid crisis is a major concern, with Americans consuming 80% of the global opioid supply and an overall increase in opioid consumption of 149%. Older adults with multiple medical problems and higher incidences of chronic pain are more likely to misuse prescription opioids.<br /><br />Barriers to identifying substance use disorders in older adults include stereotypes about addiction and older adults, lack of knowledge about treatment, denial, shame, guilt, comorbid medical conditions, age-related changes, and fewer overt warning signs.<br /><br />Treatment options for substance use disorders in older adults include tailored treatments, biological treatments (such as detoxification and maintenance medications), psychotherapeutic treatments (such as relapse prevention and motivational interviewing), social treatments (such as group therapy and family interventions), and psychosocial treatments (such as cognitive-behavioral therapy).<br /><br />Screening tools, such as MAST-G, AUDIT-C, CAGE, DAST, and SOAPP-R, can be used to identify substance use disorders in older adults during primary care visits. Brief interventions and referral to treatment are recommended based on the level of severity.<br /><br />In conclusion, substance use disorders in late life are a significant public health concern. It is crucial to screen and assess for these disorders in older adults and provide appropriate evidence-based treatments to improve health outcomes and quality of life.

Keywords

substance use disorders

tobacco

alcohol

opioids

older adults

psychoactive substance

benzodiazepine use

opioid crisis

barriers to identifying substance use disorders

treatment options for substance use disorders