When caring for an older adult, families often focus on visible health concerns like falls, chronic conditions, medication schedules, memory changes, or mobility challenges. Substance misuse may not be the first concern that comes to mind, but it can affect older adults in ways that are easy to overlook.
Alcohol, prescription medications, cannabis, and other substances can interact with aging bodies, existing health conditions, and medications in serious ways. For caregivers, family members, and community members, understanding the risks can make it easier to recognize warning signs, start supportive conversations, and connect older adults with help when needed.
Here are five statistics that help explain why substance misuse among older adults deserves more attention.
1. Nearly 1 Million Adults Aged 65 and Older Have a Substance Use Disorder
Substance use disorder is not limited to teens or younger adults. According to the 2023 National Survey on Drug Use and Health, an estimated 1.7 million adults aged 65 and older had a substance use disorder in the past year.
For families and caregivers, this can be difficult to recognize. Challenges with alcohol, prescription medications, cannabis, or other substances may overlap with chronic pain, grief, isolation, mental health concerns, or complex medication routines. Changes in mood, memory, balance, sleep, or daily habits may also be mistaken for normal aging or another health condition.
Recognizing substance misuse early can help older adults get support before the issue leads to falls, medication interactions, worsening health, or a loss of independence.
2. Many Older Adults Take Multiple Medications, Increasing the Risk of Harmful Interactions
Medication safety is an important part of substance misuse prevention for older adults. Many seniors take prescriptions for chronic conditions, along with over-the-counter medications, vitamins, dietary supplements, or cannabis products. When several substances are used at the same time, it can become harder to track dosages, side effects, and possible interactions.
About 4 in 10 older adults take five or more medications, and nearly 11 million older Americans take 10 or more medications. This matters because multiple medications can increase the risk of harmful side effects, drug interactions, falls, confusion, and medication mistakes.
Families and caregivers can help by keeping an updated medication list that includes prescriptions, over-the-counter products, vitamins, supplements, and cannabis products. It is also helpful to bring that list to medical appointments and ask a doctor or pharmacist to review whether any medications could interact or may no longer be needed.
3. Alcohol Can Affect Older Adults More Strongly Than They Expect
Alcohol misuse among older adults can be easy to overlook because drinking may seem like a normal part of socializing, relaxing, or coping with stress. However, alcohol can affect older adults differently than younger adults.
As people age, changes in body composition, liver function, kidney function, balance, and medication use can make alcohol’s effects stronger or last longer. This can increase the risk of falls, confusion, sleep problems, medication interactions, and worsening health conditions.
This is especially important for older adults who take medications for pain, sleep, anxiety, depression, blood pressure, or other chronic conditions. Families and caregivers can help by encouraging open conversations about alcohol use and reminding loved ones to ask a doctor or pharmacist whether alcohol is safe with their current medications.
4. Cannabis Use Among Older Adults Is Increasing
Cannabis use among older adults has become more common as laws, access, and attitudes have changed. A JAMA Internal Medicine study using National Survey on Drug Use and Health data found that past-month cannabis use among adults aged 65 and older increased from 4.8% in 2021 to 7.0% in 2023, a relative increase of nearly 46%. The study also found that cannabis use was more common among older adults with certain chronic conditions, including hypertension, diabetes, cancer, and chronic obstructive pulmonary disease.
Some older adults may use cannabis for pain, sleep, anxiety, or other health concerns. However, cannabis can still carry risks, especially for seniors who take prescription medications, have chronic health conditions, or are more vulnerable to dizziness, confusion, or falls. Edibles can also be difficult to dose because their effects may take longer to appear, which can increase the risk of taking too much.
Older adults should talk with a healthcare professional before using cannabis, especially if they take medications or have concerns about balance, memory, heart health, or mental health.
5. Overdose Risk Remains a Concern Across Age Groups
Older adults are not immune to the risks associated with opioids, fentanyl, stimulants, or other substances. Even when national overdose deaths decline, the overall number of overdose deaths remains high, and many overdoses involve more than one substance.
This matters for older adults because age-related health changes, chronic conditions, and multiple medications can make substance use more dangerous. Prescription opioids, sedatives, alcohol, cannabis, and substances from outside the medical system can all increase the risk of harmful interactions, confusion, falls, slowed breathing, or overdose.
Families and caregivers can help by encouraging older adults to take medications only as prescribed, avoid sharing prescriptions, store medications safely, and talk with a healthcare professional before combining alcohol, cannabis, prescriptions, or over-the-counter products.
Why Older Adults May Be More Vulnerable to Substance Misuse
Substance misuse in older adults is often connected to real health, emotional, and social challenges. Chronic pain, grief, loneliness, retirement, sleep problems, mental health concerns, and complex medication routines can all increase risk. For families and caregivers, understanding these factors can make it easier to respond with support instead of judgment.
Chronic Pain and Health Conditions
Many older adults live with chronic pain or ongoing health conditions that require medication. When pain is difficult to manage, some people may take medication more often than prescribed, combine medications with alcohol or cannabis, or continue using a medication longer than recommended. Multiple health conditions can also lead to complicated medication routines, which may increase the risk of mistakes or harmful interactions.
Social Isolation and Major Life Changes
Loss of loved ones, retirement, reduced mobility, or fewer social connections can leave older adults feeling isolated. Loneliness, boredom, depression, or anxiety may lead some people to use alcohol, cannabis, or medications as a way to cope. Staying socially connected can be an important protective factor for older adults.
Mental Health, Grief, and Trauma
Depression, anxiety, grief, trauma, and unresolved emotional stress can also increase the risk of substance misuse. Some older adults may use substances to manage difficult feelings, sleep problems, or memories they have not had support processing. When emotional health concerns are addressed early, older adults are more likely to receive care that supports both their mental and physical well-being.
Easy Access to Medications
Prescription medications are often necessary and helpful, but they can also create risks when they are not taken as directed. Older adults may have medications from multiple providers, older prescriptions still in the home, or unused pills that are easy for someone else to access. Safe storage, regular medication reviews, and proper disposal of unused medications can help reduce these risks.
Signs of Substance Misuse in Older Adults
Substance misuse can be difficult to recognize in older adults because some warning signs may look like normal aging, medication side effects, grief, depression, or another health concern. Families and caregivers should look for patterns or changes that seem unusual for the person, especially when several signs appear at the same time.
Possible warning signs may include:
- Frequent falls, accidents, or unexplained injuries.
- Confusion, memory problems, or difficulty making decisions.
- Changes in sleep, appetite, weight, or personal hygiene.
- Mood swings, irritability, anxiety, depression, or increased secrecy.
- Social withdrawal or loss of interest in regular activities.
- Missing appointments, forgetting responsibilities, or struggling with daily routines.
- Taking medication more often than prescribed or running out early.
- Mixing alcohol, cannabis, prescriptions, or over-the-counter medications.
- Unexplained spending, missing money, unusual purchases, or sudden financial decisions.
Financial changes are especially important to notice. Substance misuse can affect judgment and decision-making, which may make an older adult more vulnerable to scams, pressure from others, or unsafe financial choices. Family members and caregivers should pay attention to sudden changes in spending, new financial secrecy, or unexplained requests for money.
Not every warning sign means substance misuse is present. However, these changes are worth discussing with the older adult and, when appropriate, a healthcare professional.
How Families Can Support an Older Adult
If you are concerned about substance misuse in an older adult, start with curiosity and care rather than blame. A calm conversation can make it easier for your loved one to talk honestly about pain, stress, loneliness, alcohol use, cannabis use, or medication concerns.
Choose a private time when the person is not rushed or upset. Focus on specific changes you have noticed instead of making accusations. For example, you might say, “I noticed you have seemed more unsteady lately, and I’m worried about whether your medications could be affecting you.” This approach keeps the conversation focused on safety and support.
Families and caregivers can also help by:
- Keeping an updated list of all prescriptions, over-the-counter medications, vitamins, supplements, cannabis products, and alcohol use.
- Encouraging the older adult to review that list with a doctor or pharmacist.
- Helping store medications safely and dispose of unused or expired prescriptions.
- Watching for changes in mood, memory, sleep, balance, spending, or daily routines.
- Encouraging regular medical checkups and honest conversations about pain, sleep, stress, grief, or loneliness.
- Supporting healthy social connections through family visits, community programs, peer groups, volunteering, or other meaningful activities.
If the older adult is taking medication more often than prescribed, mixing substances, experiencing frequent falls or confusion, or becoming more isolated, it may be time to involve a healthcare professional. Support works best when it protects the person’s dignity while also taking their safety seriously.
Frequently Asked Questions About Substance Misuse in Older Adults
Signs of substance misuse in older adults may include frequent falls, confusion, memory problems, mood changes, social withdrawal, changes in sleep or appetite, poor hygiene, missed appointments, medication confusion, or unexplained financial changes. These signs do not always mean substance misuse is present, but they are worth discussing with the older adult and, when appropriate, a healthcare professional.
Older adults are more likely to take multiple medications for chronic health conditions, including prescriptions, over-the-counter medications, vitamins, and supplements. When several substances are used at the same time, the risk of side effects, drug interactions, falls, confusion, and medication mistakes can increase. A doctor or pharmacist can help review medications and identify possible concerns.
Yes. Alcohol can affect older adults differently because aging can change how the body processes alcohol. Alcohol may also interact with medications or worsen health conditions. Even moderate drinking can increase the risk of falls, sleep problems, confusion, medication interactions, or other health concerns for some older adults.
Cannabis can carry risks for older adults, especially for those who take prescription medications, have chronic health conditions, or are more vulnerable to dizziness, confusion, memory issues, or falls. Edibles can also be difficult to dose because their effects may take longer to appear. Older adults should talk with a healthcare professional before using cannabis, especially if they are managing other health concerns.
Families should start with care, curiosity, and specific observations rather than blame. Choose a private time and focus on safety, health, and support. For example, instead of accusing someone of misusing medication, a family member might say, “I noticed you’ve seemed more unsteady lately, and I’m wondering if your medication could be affecting you.” Keeping the conversation calm and respectful can make it easier to connect the person with help.
If you are worried about an older adult’s substance use, start by documenting the changes you have noticed, such as falls, confusion, medication issues, isolation, mood changes, or unusual spending. Then, try to have a calm conversation focused on safety and support. Encourage the person to speak with a doctor, pharmacist, counselor, or other trusted professional. If there is an immediate safety concern, such as overdose symptoms, severe confusion, or danger of harm, call emergency services.
Older adults can reduce the risk of medication misuse by taking medications only as directed, using one pharmacy when possible, keeping an updated medication list, avoiding alcohol or cannabis unless a healthcare professional says it is safe, and disposing of unused or expired medications properly. Regular medication reviews with a doctor or pharmacist can also help identify drug interactions, duplicate prescriptions, or medications that may no longer be needed.