Older Adults

Abstract

The prevalence of substance use among older adults is expected to increase, particularly as the Baby Boom Generation (those born between 1946 and 1964) ages. In geriatric mental healthcare, patients have either aged with their disorder or they develop it in late life, and problematic use may be missed. When assessing an older individual, it is important to remember the unique issues they face and that the clinical picture of their substance use disorder often differs significantly compared to that of a younger person. As people age, changes occur in multiple organ systems at a rate not seen in most since adolescence. Like teenagers and young adults, geriatric patients often are encountering multiple body and social changes. While aging in and of itself is not a pathological process, in patients with addiction problems, their use of substances may cause or promote the development of various kinds of pathology or deviance from the normal aging process. The chronic misuse of substances can adversely affect the aging process, and as patients with substance use age, the normal changes that occur with advancing years can influence the course and management of an addiction. With the myriad of changes occurring in the geriatric patient, working with older adults with addiction requires understanding the unique circumstances in which these patients find themselves.

Review Questions

• 1. An 85-year-old African-American male presents to his PCP with complaints of chronic back pain secondary to sports injuries. He denies a prior history of substance use, but admits that he enjoys a cocktail several days a week at the exclusive country club at which he plays golf and is a member. Which of the following factors increase the risk of this patient misusing alcohol?

  • A. Non-Caucasian race

  • B. Old-old age status (>80 y/o)

  • C. Affluence/financial resources

  • D. Negative prior history of substance misuse

  • E. Active lifestyle

  Answer: C: Affluence/financial resources

  Explanation: Risk factors for alcohol misuse in late life include male gender, affluence, Caucasian race, and being young-old (in the early stages of late life). Therefore, having more financial resources and longer financial horizons is a predictor of increased drinking in older age. Patients with a prior history of substance use and decreased activity due to pain/medical problems are also at higher risk of alcohol misuse.

• 2. A 71-year-old female presents to your office for concerns about concentration and memory. During the evaluation, you ask about substance use and learn that she smokes marijuana that her grandson gets from a medical marijuana dispensary every night “to sleep.” What are the top three substances used by US adults 50 years and older?

  • A. Alcohol, Benzodiazepines, Opiates

  • B. Alcohol, Cannabis, Opiates

  • C. Cannabis, Opiates, Tobacco

  • D. Alcohol, Tobacco, Cannabis

  • E. Cocaine, Alcohol, Opiates

  Answer D: Alcohol, Tobacco, Cannabis

  Explanation: Cannabis is the most prevalent drug after alcohol and tobacco used by adults 50 years and older in the United States and United Kingdom.

• 3. A 72-year-old female presents seeking treatment for alcohol misuse after her family stated that she needed to get help during an “intervention” in which her children and grandchildren participated. Which of the following criteria would she be less likely to endorse than a middle-aged or younger patient?

  • A. Physical/Psychological Problems

  • B. Social/Interpersonal Problems

  • C. Tolerance

  • D. Physically Dangerous Situations

  • E. All of the above

  Answer E: All of the above

  Explanation: Due to various social and physical factors, older adults are less likely than their younger cohorts to report social and physical/psychological problems, tolerance, and being in physically dangerous situations. Thus, it has been proposed that the DSM criteria to identify substance use disorders in the older adult are less applicable than they are for younger adults.

• 4. A 62-year-old male American Indian reports having little alcohol consumption in his youth, but since he retired 2 years ago, he feels bored and will often starting drinking at lunch time and consume 5–6 beers before he goes to bed at night. Older adults who consume alcohol are at greater risk of functional impairment and alcohol related problems due to which of the following physiological changes associated with aging?

  • A. Decreased Permeability of Blood-brain Barrier

  • B. Lowered Hepatic Metabolism of Alcohol

  • C. Lowered Neuronal Receptor Sensitivity

  • D. Increased Lean Mass

  • E. Increased Total Body Water

  Answer B: Lowered Hepatic Metabolism of Alcohol

  Explanation: As the percentage of lean body mass and total body water decrease with age, the ability of the liver to process alcohol is also decreased, while the permeability of the blood-brain barrier and neuronal receptor sensitivity to alcohol increase.

• 5. A 79-year-old African-American female reports daily cannabis use since her late teenage years when she was a “groupie,” following her favorite classic rock bands around the country. She cannot remember a period without using cannabis for more than a few days. Cannabis use in older adults has been linked with the following adverse effects?

  • A. Frontotemporal Dementia

  • B. Migraines

  • C. Alzheimer’s Dementia

  • D. Cerebrovascular Events

  • E. Parkinson’s Disease

  Answer D: Cerebrovascular Events

  Explanation: Cannabis has been tied to cerebrovascular events. Although cannabis has acute effects on cognitive function and may have residual long-term effects, there is no current evidence linking cannabis use to the development of neurodegenerative disorders such as Parkinson’s, FTD, or Alzheimer’s, nor to development of migraines in older adults.