An abstract

Author: Peter Bechtel, President/CEO WellTrackONE Corporation, March 23, 2018

The drug problem in seniors is growing steadily.  Maintaining vigilance is the key to effective recognition and treatment.

As baby boomers flood the healthcare landscape, we are seeing a surprisingly high pattern of illicit substances in a pattern not seen in prior generations of older adults1. In previous generations, the prevalence of these kinds of disorders typically lowered with advancing age.

A 2013 Substance Abuse and Mental Health Services Administration survey found that the percentage of adults ages 50 to 64 who use illicit substances increased from 2.7% in 2002 to 6.0% in 20132.

It is interesting to note that a plethora of studies have estimated the incidence and prevalence of drug abuse in younger populations. However, far fewer studies have focused on elderly persons. Furthermore, several methodological problems, including inappropriate definitions, may have resulted in low estimates. Studies using currently available diagnostic criteria for substance abuse are likely to significantly underestimate the prevalence of drug abuse among elderly persons because the criteria were developed and validated in young and middle-aged samples; the criteria may have only limited utility among elderly populations5.

This abstract will seek to identify the (1) risk factors and (2) discovery methodologies that may be utilized by primary care physicians when dealing with their elderly patients.

Risk Factors for substance abuse in older adults3

Individual, social, and familial factors can contribute to substance use and abuse in late life.  Below is a table that outlines some of the potential risk factors for older adults associated with the use of illicit substances.

Physical risk factors Psychiatric risk factors Social risk factors
Male sex (for alcohol) Previous substance abuse Bereavement
Female sex (for prescription drugs) History of or current psychiatric illness Forced or unexpected retirement
White/Caucasian History of alcohol problems Living alone
Chronic pain Avoidance coping style Social isolation
Chronic physical illness Lower economic status
Polypharmacy or significant drug burden
Physical disabilities
Poor health status

A 2014 study of geriatric patients found that of the 1,302 patients age greater than or equal to 65 years admitted to a Level 1 trauma center, 48.3% had a positive urine drug screen7.  Some researchers have estimated that 5.7 million older adults will require treatment for a substance use disorder in 2020, which is roughly double the 2.8 million who had an SUD in 2002 to 20068.

Discovery methodologies and associated challenges

There are a number of methods that can be applied toward the goal of determining what habits your patients have that may be deemed or contribute toward substance abuse patterns.  The one method that is consistent is the Annual Wellness Visit.  While a good number of PCPs do not take the time to have their patients undergo an annual wellness screening, those that do are seeing patterns in their patients’ behaviors that would otherwise go undetected.

Most of the risk factors in the table presented above are captured and made available to PCPs through a cohesive and concise Annual Wellness Visit program such as the WellTrackONE system.  Data categories such as Social History, Active Daily Living (ADL and iADL) data and Social Determinants contribute toward the identification of risk factors for this population.  Medication reconciliation (identifying those medications taken from ALL sources vs those prescribed in the EHR) is a critical need for the polypharmacy patient’s risk factors for substance abuse and must be an integral component of a solid Annual Wellness Visit program.

WellTrackONE has a unique method of conducting the Annual Wellness Visit that is (1) non-disruptive to the staff, (2) pleasing to the patient and (3) beneficial to the revenue stream of the practice.  Click here to learn more.

While the Annual Wellness Visit is an excellent tool for substance abuse discovery, it is far from foolproof.  Diagnosis can be easily overlooked because the signs and symptoms of illicit substance use can be mistaken for other illnesses.  To complicate matters further, older adults often do not disclose their substance use, understate it, or even try to explain away their symptoms3.  Furthermore, many older adults live alone, which may increase their risk of receiving no treatment6.

Summary

The number of older adults who use illicit substances is increasing.  Screening, diagnosis, and treatment of substance use disorders in these patients may be complicated by age-related factors and a lack of evidence specific to older adults.  Maintaining a high index of suspicion for substance use by older adults is essential4.

References

 

  1. James Cho, MD, Jay Bhimani, MD, Milapkumar Patel, MD, Matthew Navin Thomas, MBBS. Current psychiatry – Vol 17, No. 3, March 2018, p15-20
  2. Taylor MH, Grossberg GT. (2012). The growing problem of illicit substance abuse in the elderly: a review.  Prim Care Companion. CNS Discord. 2012 14(4) PCC.11r01320.  doi:10.4088PCC.11r01320.
  3. Kuerbis A, Sacco P, Blazer DG, et al. Substance abuse among older adults. Clin Geriatr Med. 2014;30(3);629-654
  4. James Cho, MD, Jay Bhimani, MD, Milapkumar Patel, MD, Matthew Navin Thomas, MBBS. Current psychiatry – Vol 17, No. 3, March 2018, p20
  5. Thomas L. Patterson, Ph.D., and Dilip V. Jeste, M.D. – Published online: September 01, 1999 –  https://doi.org/10.1176/ps.50.9.1184
  6. West LA, Cole S, Goodkind D, et al. US Census Bureau, P23-212. 65+ in the United States 2010. Washington, DC United States Census Bureau: 2014.
  7. Ekeh AP, Parikh P, Walusimbi MS, et al. The prevalence of positive drug and alcohol screens in elderly trauma patients. Subst Abus. 2014;35(1):51-55.
  8. Wu LT, Blazer DG. Illicit and nonmedical drug use among older adults: a review. J. Aging Health 2011;23(3):481-504.