With the aging of the population, and particularly the entry of the “Baby Boomer” cohort into the older adult population, it is useful to reconsider guidelines for drug and alcohol use among older adults. Because this newer cohort of older adults (as well as subsequent generations) seems to recreationally use drugs at a higher rate than previous generations, there is likely to be an increase in recreational drug use among older adults. However, most research frameworks and practice guidelines on substance use are more oriented to adolescents and younger adults. In a recent article, two geriatric psychiatry researchers offer guidelines for evaluating and understanding substance use among older adults.
The authors point out factors that call into question the use of standard substance abuse screenings and interventions for older adults. These methods have been developed for younger individuals, but may not apply as well for older adults for reasons that include:
- Physiological changes in aging that influence the effects of drugs;
- The higher rate of prescribed medication and chronic medical conditions among older adults;
- Standard diagnostic criteria for substance abuse may not apply to older adults, whether for the abovementioned reasons (drug tolerance, for example, is less likely to physiologically develop) and for social reasons (problems related to work, for example, are more likely to be relevant to younger individuals than to older adults).
The authors offer screening advice for clinicians who are concerned with an older adult’s use of drug or alcohol, such as asking questions about substance use in the recent past and asking about them in the context of other health related issues (such as weight change or physical activity). The authors note a few practical considerations that make even evidence-based practices difficult to apply in real-world settings, such as stigma about behavioral health interventions, chronic medical conditions that can make it difficult to gauge to what extent substance abuse may be interfering with quality of life, and the role of multiple drug prescriptions. There is a need for further research on substance abuse that focuses on the experiences and realities of older adults.
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