Substance abuse is a real and worsening problem among older Americans.

The reality is that people who abused alcohol or drugs (prescription or street) in youth or middle age aren’t likely to stop just because they have added more years to their age. In fact, they may be more inclined to overuse as the emotional and physical tolls of aging grow.

Seniors with substance abuse problems can be found in every setting – whether they live independently or with their families, in independent living apartments or in any type of senior care facility. When not identified and addressed, those operating senior care facilities can be found liable for failing to meet standard-of-care requirements required by federal law.

Understanding the extent of the risk is one issue. But the senior care sector needs to do a better job of identifying and treating those at risk to effectively manage the costs.

What’s behind worsening senior substance abuse

Data from the federal Substance Abuse and Mental Health Services Administration (SAMHSA) show a big jump in the prevalence of aging Americans that abuse alcohol and  pharmaceuticals.

By 2020,167,200 people 55 or over – 53% more than in 2009 – were admitted to addiction treatment. One estimate puts the prevalence of substance abuse by those over 65 at 4% of the population. Fatal overdoses also have soared.

Alcohol is the most abused substance among the aging. But pharmaceuticals abuse is also common. Elderly adults in pain are often prescribed two types of medications with a high potential for misuse or abuse – OxyContin and Vicodin. The rate of overdose deaths among them quadrupled to 12 from 3 per 100,000 between 2002 to 2021. Some were intentional; others reflected drug interactions and errors.

Some suggest that Baby Boomers’ (46% of whom are now 65 or older) exposure to and acceptance of alcohol and drugs at a younger age may have influenced the trend. But today’s seniors are as likely as earlier generations to self-medicate to manage the stressors of late-life changes – like health issues, isolation, loss of independence and lifestyle changes.

It’s one thing for a younger, fairly healthy person to have a glass or two of wine at night. But a senior craving that now risks advancing, or worsening, the sort of co-occurring illnesses that accompany old age.

Recognizing and managing substance abuse behaviors

It’s incumbent on senior care facilities and communities, beginning with the intake process, to do an adequate job of assessing residents in a holistic way to detect behaviors that could signal developing mental health issues or substance abuse. Importantly, those assessments must be ongoing.

Too often, this is not done well. It may stem from a lack of skills and/or knowledge to ask the right questions. Organizations also may not have created and documented policies and procedures to detect and monitor such behaviors and signs they are worsening – much less trained staff in assessment procedures.

Senior living facilities funded by Medicare are required to perform these assessments and must demonstrate to surveyors with the Centers for Medicare and Medicaid Services (CMS) that they comply. Other senior communities don’t have the same legal requirements but have a responsibility to monitor and a potential liability if they don’t.

Numerous resources are available to the senior living community to advance caregivers’ understanding of and capabilities in screening, monitoring and treating residents with addiction issues. Among them:

• SAMHSA Resource Center offers an expansive selection of publications on topics (in multiple languages) ranging from overdose prevention and response, and an updated toolkit to counseling approaches to promote recovery.
• The Center of Excellence for Behavioral Health in Nursing Facilities provides a resource hub that draws from a variety of agencies and organizations.
• The Alliance for Aging Research’s white paper on substance abuse disorders and mental health in aging adults offers screening and treatment recommendations.

About the author

Gigi Acevedo-Parker is National Practice Leader – Clinical Risk Management, for global insurance brokerage Hub International.

She is a nurse executive with more than 30 years as a healthcare clinician, nursing leader, healthcare consultant and educator with a focus on healthcare risk mitigation and patient safety. Gigi has deep experience in many diverse aspects of risk management and compliance, including loss prevention and mitigation, patient safety and quality, claims and litigation management, corporate compliance and privacy.