There used to be this thing called the “golden years.” Where did they go? It seems like now when you approach an age group that used to be celebrated, the worst news awaits. Dr. Benjamin Han is a geriatrician and addiction medicine specialist at the University of California, San Diego School of Medicine. As he recently explained to New York Times reporter Paula Span, Han has now had to alter his conversation with patients about the normal health issues that older adults face — such as chronic conditions, functional ability or how their medications are working — to add a new line of questioning. Added now are questions about their use of tobacco, alcohol, cannabis and other nonprescription drugs.
“As you get older, there are physiological changes and your brain becomes much more sensitive,” he now cautions them. “Your tolerance goes down as your body changes. It can put you at risk.” His goal here is to get them to open up about any issues of substance abuse.
“That’s how he learns that someone complaining about insomnia might be using stimulants, possibly methamphetamines, to get going in the morning,” writes Span. “Or that a patient who has long taken an opioid for chronic pain has run into trouble with an added prescription … Until a few years ago, even as the opioid epidemic raged, health providers and researchers paid limited attention to drug use by older adults; concerns focused on the younger, working-age victims who were hardest hit.”
What researchers are now learning is that substance use disorders among the older population are climbing steadily. For instance, a study of opioid use disorder in people over 65 enrolled in traditional Medicare showed a threefold increase in between 2013 and 2018.
Adds Keith Humphreys, a psychologist and addiction researcher at the Stanford University School of Medicine, aging baby boomers “still use drugs far more than their parents did, and the field wasn’t ready for that.” According to the Times report, fatal overdoses have soared: “From 2002 to 2021, the rate of overdose deaths quadrupled.”
Drug abuse by older people isn’t always intentional. “Most substance use disorders among older people involve prescribed medications, not illegal drugs,” Dr. Humphreys notes. “The more complicated the regimen, the easier to make mistakes. And then you have an overdose.” Reports Span, the numbers of overdose deaths so far remain comparatively low — 6,700 drug overdose deaths in 2021 among people 65 and older — but the rate of increase the experts are seeing is alarming. “Although most people with substance use problems don’t die from overdoses, the health consequences can be severe: injuries from falls and accidents, accelerated cognitive decline, cancers, heart and liver disease and kidney failure,” says the Times report.
According to the Times, a study last year of substance use disorders analyzing which drugs older Americans were using showed more than 87% abused alcohol. In 2020, alcohol is said to have accounted for 11,616 deaths among seniors, an 18% increase over the previous year.
A study looking at Medicare enrollees shows that few seniors underwent treatment for addiction in the past year or tried to seek treatment. Just 6%, compared with 17% of younger Medicare beneficiaries.
“We see higher rates of stigma concerns, things like worrying about what their neighbors would think,” says Dr. William Parish, the lead author of the study. Also pointed out are the “logistical barriers,” such as finding transportation, not knowing where to go for help and being unable to afford care. In addition, doctors, unaccustomed to diagnosing substance abuse in older people, may be overlooking a patient at risk.
As if this wasn’t enough challenges placed on older people today, unprovoked anger exhibited by some of these folks is raising concerns. A recent posting on Care.com, an online marketplace for child care, senior care and special needs care, suggests that the unprovoked anger being expressed by older adult could be a sign of something more serious.
Dr. David A. Merrill is an adult and geriatric psychiatrist and director of the Pacific Neuroscience Institute’s Pacific Brain Health Center at Providence Saint John’s Health Center in Santa Monica, California. “It’s not normal for previously non-hostile older adults to start exhibiting ongoing, repeated, out-of-character aggression,” he explains. This can include a readiness to fight, both physically and verbally, and is often indicative of a health issue that warrants immediate attention. “When the behaviors are unprovoked, not associated with any clear triggers or stressors, then it’s worth considering if something more biologic or brain-based is going on beyond a bad day,” he adds. “There’s a solid chance their anger is stemming from an internal factor rather than an external one.” It’s either a biologic or neurologic issue.
Brittany Ferri, a registered and licensed occupational therapist specializing in older adults, has found “one major reason for senior aggression is urinary tract infections (UTIs), which account for nearly one-third of infections in long-term care facilities,” says Care.com reporter Julia Sullivan. Dr. Merrill agrees. “Acute medical illnesses like urinary tract infections, viral illnesses like COVID-19, pneumonias or skin infections can also cause acute bouts of aggressive responses,” he explains. “If a senior’s aggressive behavior is seemingly out-of-the-blue and becomes more consistent, it’s time to enlist professional help,” says the Care.com report.
And the beat goes on. As pointed out in a 2018 report from the Centers for Disease Control and Prevention, age is not necessarily an impediment to sexual activity, nor is it to potential disease transmission. According to the CDC report, sexually transmitted diseases are on the rise in America across the board and among all ages.
According to a U.S. News report, in 2017, nearly 2.3 million cases were reported among older adults. An “analysis of patients on athenahealth’s network found that patients over age 60 account for the biggest increase of in-office treatments for sexually transmitted infections,” writes Elaine K. Howley.
While the heaviest burden of sexually transmitted infections is in younger people, Dr. Janet Pregler, director of the University of California, Los Angeles Women’s Health Center, hard data about older adults is scarce because “we haven’t tracked or studied this in older adults effectively at all.”
According to a 2021 CDC news release, it is estimated that on any given day in 2018, 1 in 5 people in the U.S. had a sexually transmitted infection.
At a time when this preventable and treatable national health threat was at an all-time high, the subject has “fallen out of the national conversation,” says Pregler.
