Substance Misuse in Seniors: Why Older Adults Are at Risk & How to Help

Senior Sense February 19, 2025March 2, 2025

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Substance misuse is often associated with younger populations, but older adults are increasingly affected. In the 2022 Treatment Episode Data Set (TEDS) report (the most recently published report), there were 60 substance use treatment admissions per 100,000 people aged 65 and older, highlighting a growing concern​. Factors like chronic pain, social isolation, and cognitive decline contribute to this risk, making it essential to understand and address the causes.

By identifying key risk factors—such as medication mismanagement, depression, and physical health issues—healthcare providers and families can take proactive steps to prevent substance misuse in senior adults. Here’s what you should know.

How Memory Impairment Increases Substance Misuse Risk in Seniors

Memory impairment and substance misuse among the elderly are interconnected issues that can have serious consequences for their overall well-being. As individuals age, their cognitive abilities, including memory, naturally decline. However, substance misuse, such as excessive alcohol consumption or drug misuse, can exacerbate these cognitive deficits.

The misuse of substances among the elderly can directly impact memory function. Chronic alcohol misuse, for instance, can lead to significant memory impairment, including both short-term and long-term memory problems. Similarly, certain drugs, especially those with sedative effects, can impair memory formation and retrieval.

Furthermore, substance misuse among the elderly can indirectly contribute to memory impairment by increasing the risk of other health conditions, such as cardiovascular diseases and liver damage, which can further compromise cognitive function. Additionally, substance misuse may lead to social isolation and depression, which are known risk factors for cognitive decline and memory problems.

Chronic Pain, Opioids, and Substance Misuse in Older Adults

Chronic pain is a common and debilitating condition among senior adults, often resulting from age-related ailments such as arthritis, neuropathy, or back problems. Effective management of chronic pain is essential for maintaining the quality of life in this population. However, it is important to recognize that there is a potential risk of substance misuse associated with pain management in senior adults.

Senior adults may be prescribed opioid medications to alleviate their chronic pain. While opioids can provide relief, they also carry a significant risk of misuse and addiction. Older adults may be particularly vulnerable due to factors such as increased sensitivity to medications, multiple prescriptions, cognitive decline, and social isolation.

Moreover, senior adults may turn to self-medication as a means of managing their pain, using over-the-counter medications, alcohol, or other substances in excessive amounts. This can lead to an increased risk of substance misuse and adverse health effects.

To address these risks, healthcare providers should adopt a comprehensive approach to chronic pain management in senior adults. This includes regular monitoring of medication use, assessing the risk of substance misuse, considering non-opioid alternatives, and providing education and support for self-management techniques. Additionally, a multidisciplinary approach involving healthcare professionals, psychologists, and social workers can help identify and address underlying factors contributing to chronic pain and substance misuse, promoting healthier and safer pain management strategies for senior adults.

Accidental Substance Misuse in Seniors: Causes, Risks, and Prevention

Accidental substance misuse among senior adults is a concerning issue that requires attention and understanding. As individuals age, changes in metabolism, cognitive function, and medication regimens can increase the risk of unintentional misuse of substances.

One contributing factor to accidental substance misuse is the complexity of medication management. Senior adults often take multiple medications prescribed by different healthcare providers, which can lead to confusion and potential interactions. Memory impairments and difficulty reading the small print on medication labels further compound the risk.

Additionally, age-related physiological changes can alter the way substances are processed in the body. Reduced liver and kidney function, as well as changes in body composition, can impact drug metabolism and increase the likelihood of unintended overdoses.

Furthermore, senior adults may be more susceptible to unintentional substance misuse due to factors such as social isolation, limited social support, and inadequate education about proper medication use.

To address accidental substance misuse in senior adults, health care providers should prioritize comprehensive medication management. This includes conducting regular medication reviews, simplifying medication regimens, providing clear instructions and labels, and using technology aids such as pill organizers and reminder systems. Patient education and involvement, along with regular communication between health care providers, caregivers, and pharmacists, are essential in preventing accidental substance misuse and promoting the safe and effective use of medications among senior adults.

The Link Between Social Isolation and Substance Misuse in Senior Adults

Addressing social isolation is crucial in preventing substance misuse among senior adults. Social isolation, characterized by limited social interactions and a lack of meaningful connections, can contribute to feelings of loneliness, depression, and anxiety, leading to a higher risk of substance misuse.

Engaging senior adults in social activities and fostering social connections is key. Community-based programs, senior centers, and support groups provide opportunities for socialization, recreation, and engagement. These initiatives help combat feelings of loneliness and provide a sense of belonging and purpose.

In addition, involving family members, friends, and caregivers in the lives of senior adults can create a support network that reduces the likelihood of substance misuse. Regular visits, phone calls, and involvement in family activities help maintain social connections and emotional well-being.

Furthermore, health care professionals should be vigilant in screening for social isolation during routine assessments. Identifying at-risk individuals allows for targeted interventions, such as referrals to social services or mental health professionals, to address social isolation and prevent substance misuse.

By recognizing the importance of social connections and implementing strategies to combat social isolation, we can create a supportive environment for senior adults, reducing their vulnerability to substance misuse and promoting healthier aging.

Common Risk Factors for Substance Misuse in the Elderly

There are many reasons why senior adults might end up misusing or even abusing substances like alcohol or medication. Here are a few common risk factors:

• Depression
• Confusion
• Chronic pain/illnesses requiring medication
• Social isolation
• Lack of support
• Anxiety
• Grief/loss
• Lack of medical counseling
• Changes in routine

It’s important to note that substance misuse can be accidental. In many cases, senior adults, especially those with memory impairments, forget they already took their prescribed medication or confuse their dosage. In this case, it’s likely time for a caregiver to step in.

The Most Commonly Misused Substances Among Older Adults

Certain types of substances are misused by senior adults more than others. However, each comes with risk factors and dangers. Here are some commonly misused substances — and reasons why senior adults are especially susceptible to misusing them.

Prescription meds

Over 80% of senior adults are prescribed at least one medication, with almost half taking more than five medications or supplements daily. Often, especially if unreported to their doctors, these medications can cause adverse side effects or interactions when mixed.

Additionally, senior adults who are confused or forgetful might mess up their dosage, which can be detrimental to both their physical and mental health.

Opioids

Some older adults who battle chronic conditions or illnesses take opioids for pain management. While helpful in small doses and for an appropriate period of time, opioids can be extremely addictive and even act as a gateway to more dangerous drugs like heroin.

Marijuana

Marijuana has been legalized in some states and the general public’s views on the drug have begun to shift in recent years. Proponents of the drug state it is a resource for pain management, better sleep, and mental health, and many senior adults rely on it for those very reasons. However, regular use of this drug has been linked to respiratory conditions, depression, impaired memory, altered motor skills, and more. It can also interact with prescription drugs, which many elderly patients take daily.

 Nicotine

Many senior adults smoke cigarettes, which can increase their risk for heart disease, cancer, and more. Misusing nicotine among the elderly can have detrimental effects on their health. Nicotine addiction can worsen existing medical conditions, increase the risk of cardiovascular problems, and contribute to cognitive decline.

 Alcohol

NIDA stated that 65% of adults 65 and older reported high-risk drinking, with more than one-tenth of older adults binge drinking. This is especially concerning if these adults take prescription medications that interact with alcohol.

Alcohol and Seniors: Understanding the Risks of High-Risk Drinking

Educating senior adults on the risks of alcohol misuse is essential to promote their well-being and prevent adverse health outcomes. While moderate alcohol consumption may have some health benefits, excessive or inappropriate alcohol use can have serious consequences for senior adults.

One key risk is the increased sensitivity to alcohol that comes with age. Older adults may experience changes in metabolism and body composition, leading to higher blood alcohol levels and increased vulnerability to alcohol-related problems. Moreover, alcohol can interact negatively with medications commonly prescribed to senior adults, potentially causing harmful side effects or reducing the effectiveness of the medications.

Educational efforts should focus on raising awareness about the specific risks associated with alcohol misuse in older adults. This includes providing information about the potential impact on physical health, mental well-being, cognitive function, and medication interactions. It is crucial to emphasize the importance of responsible drinking habits and encourage open dialogue with health care providers regarding alcohol use.

Furthermore, education should address alternative ways to cope with stress, loneliness, and other emotional challenges that may lead to alcohol misuse. Encouraging participation in social activities, hobbies, and support networks can provide healthier outlets for emotional well-being.

By providing comprehensive education on the risks of alcohol misuse and promoting healthier coping strategies, we can empower senior adults to make informed decisions about alcohol consumption, ultimately improving their overall health and quality of life. 

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