Older Adults and Substance Use Disorders: It’s Real

Revised March 21, 2022

As we age, our bodies change. The number of prescription medications a person needs increases with age, and many people over 65 might need to take several pills a day. It can be difficult to keep track of them all, especially when our brain chemistry also undergoes age-related changes.

Although not as severe or prevalent as among younger people, substance use disorders in older adults (65+) are happening — and they can have a devastating impact on the older adult and their family. The most abused and addictive prescription drugs are opioid painkillers, tranquilizers, and amphetamines.

Medication control for seniors is a frequently overlooked issue. Some seniors may have trouble remembering to take their prescription medications at all, but others may take too much — intentionally or not. Memory problems contribute greatly to this issue. On this page, we take a closer look at this growing problem and how you can intervene.

Substance Abuse By the Numbers

According to the Substance Abuse and Mental Health Services Administration’s 2015 National Barometer Survey, 0.4% of adults age 65+ were dependent on or abused illicit drugs in 2013. To specify, examples of illicit drugs are marijuana, cocaine, and prescription drugs (pain relievers, sedatives, tranquilizers, and stimulants). In the same survey, 2.2% of people 65+ were dependent on or abused alcohol in 2013. Looking back at the population from 2013, there were 44.7 million adults aged 65+. With some quick math, this means over a million older adults were having a substance use issue. 

However, some misuse of medications may be accidental. In a study by the University of Illinois at Chicago, one in six older adults (ages 62-85) use possibly deadly combinations of prescription and over-the-counter medications and dietary supplements. 

Polypharmacy (or the use of five or more drugs), which is potentially harmful, happens when there is a lack of communication, misinformation, or confusion. To avoid this, it’s beneficial for older adults to make a list of medications and bring it to doctor appointments or when visiting the pharmacy. 

However, some patients may be going from one pharmacy to another, or "doctor shopping," to intentionally obtain more medications.

Warning Signs of Substance Use Disorder in Seniors

Here are some red flags that may reveal substance use disorder by an older loved one from the National Council on Alcoholism and Drug Dependence:

• Hostility or depression

• Disregard for alcohol interaction labels on prescription bottles

• Memory loss and confusion

• Immediate or frequent use of tranquilizers

If you believe your older loved one has a substance use disorder, contact their doctor. Older adults have greater risks of harm because there is an increased chance of prescription and alcohol interactions, changes in metabolism, and higher rates of comorbidities (multiple chronic conditions). 

Another risk factor is the low level of water typically present in an older adult’s body. Water dilutes alcohol, thus lowering its effects. Due to their lower hydration levels, older adults will feel the symptoms of being intoxicated more readily, according to the National Institutes of Health.  Moreover, in a recent study by the Journal of the American Geriatrics Society, researchers found 10.6% of adults aged 65 years or older binge drink.

Substance use disorders in older adults can occur later in life or can be a continuance from early years. The Office of Alcoholism and Substance Abuse Services classifies these two types as “late-onset” and “hardy survivor.” The catalysts and triggers for addictions in older adults are relatively universal:

• Death of a loved one

• Retirement

• Family conflict

• Physical and/or mental decline

• Moving from their home or placement into a facility

Aging brings many new changes, which can feel overwhelming to you and your older loved one. ComForCare Home Care services help minimize the stress of relocation and keep your loved one where they feel most comfortable: at home. We provide specially trained caregivers and respite care for when you need a break from your caregiving duties. For a fast, free consultation, call 800-886-4044 or find a ComForCare location near you. 

Prescription Medication Management Tips

Medication management and medication safety are crucial parts of any home health care plan. If you’re concerned an older adult in your life is struggling with prescription drug abuse, or if you simply want to practice safe medication management practices, here’s what you can do:

• Check expiration dates. Most people don't think about medication expiring the same way food in your fridge does, but you should always check the date before use! Routinely clean out unused medication from the medicine cabinet to reduce the chances of overdose.

• Check medication interactions. Many drug interactions can be dangerous and even life-threatening. Even vitamin supplements, antibiotics, and over-the-counter pain relief medication can interact negatively with some prescription medications. Don’t trust a cursory web search either; discuss these interactions with your doctor or pharmacist.

• Watch their diet. Other drugs aren't the only thing you should look out for! Citrus fruits like grapefruits and oranges can interfere with the efficacy of certain medications for high blood pressure, cholesterol, and many other issues. Discuss these interactions with the pharmacy or healthcare provider.

• Be aware of all potential side effects. Certain medication may have serious side effects. Look out for drastic weight loss, low blood sodium, decreased function of the kidneys, liver, or heart, and more.

• Look out for withdrawal symptoms. If they accidentally skip doses or if they are abusing their prescriptions, a patient may experience sweating, shaking, yawning, aches, increased heart rate, nausea or vomiting, and dilated pupils.

• Organize medications into different color-coded pill organizers and label them clearly to avoid potential confusion. Seniors may have difficulty reading medication labels on pill bottles, especially if the fine print is the only distinguishing feature among a dozen orange bottles. Keep a medication list visible in the home and easily accessible.

• Lock up medications if necessary. A home caregiver may need to be responsible for giving daily medications.

• Communicate clearly and frequently with your loved one's healthcare providers. Medication adjustments and higher or lower doses may be necessary depending on how the patient reacts to them or how possible side effects are impacting their life.

• Consider comorbidities. As mentioned above, alcohol use disorder often occurs simultaneously with substance use disorder, especially in older adults dealing with depression or physical health problems. Mixing alcohol with prescription medication can be fatal.

• Be proactive. If you feel an intervention is necessary, don't wait. 

Together with caregivers and healthcare professionals, you can collaborate on a supervised medication assistance plan.

Whether medication management issues stem from impaired memory, depression, substance abuse, or another issue, ComForCare can help you address them with patience and sensitivity. Call us now at 800-886-4044 or find a ComForCare location near you for a free consultation.

Prescription Drugs & Medication Reviews

If you are worried about substance use disorder, consider arranging an appointment for a medication review.

Medication reviews are comprehensive, confidential checks held by doctors or pharmacists on the medication used by their patients. The objective of a medication review is to ensure medication is effective. It is also a time to check if the patient is using the medication as directed (not taking too much or too little of it), how it is making them feel, if they are taking anything that may interact with it, and if they are dealing with any side effects.

A medication review is also a great time for you to ask questions about your loved one's treatment plan. To ensure a medication review is thorough, keep a detailed record of all their prescription drugs, OTC drugs, vitamins, herbs, and dietary supplements. Keep this list accessible at all times, especially at medical appointments. If they have to start on a new medication, keep close watch as they adjust.

ComForCare Supervised Medication Assistance: Help with Medication Control for Seniors

Older adults may not follow medication plans due to forgetfulness, unwanted side effects, a belief that the medicine isn’t working, or high costs. Not following prescription medication instructions is called "non-adherence."

However, sometimes the problem is more serious than mere forgetfulness.

If you suspect your aging loved one may have a substance abuse problem, we're here for you. Supervised medication assistance is a team effort, and that team may need to include more than just your family and a primary care provider. With our patient-centered approach to care, ComForCare’s compassionate and responsible caregivers treat seniors with the respect, support, and sensitivity they deserve.

For help with home care, medication management, and medication-assisted treatment, call ComForCare at 800-886-4044 or find a location near you.

Editor’s note: This article was originally published August 4, 2016. It has been revamped and updated for accuracy and comprehensiveness.